Procedural and Mid-Term Results in Patients With Aortic Stenosis Treated With Implantation of 2 (In-Series) CoreValve Prostheses in 1 Procedure

Objectives This study sought to assess post-procedural and mid-term outcome of patients, in which a second "in-series" CoreValve prosthesis (Medtronic, Minneapolis, Minnesota) was implanted during the same procedure. Background Because of the increasing number of patients implanted with CoreValves, the need for management of special complications has emerged. A misplaced prosthesis can be corrected by various maneuvers. An option is to pull the valve out of the aortic annulus into the ascending aorta or beyond and position a second one (in series). Methods Out of 277 patients who underwent CoreValve implantation with the 18-F device in our institution, we had to implant a second prosthesis (due to severe aortic regurgitation or dislocation of the first one) in 9 (3.2%). Immediate post-procedural as well as mid-term follow-up data (5 to 20 months, mean 10.6 +/- 6 months, total 95 patient-months) were collected for analysis. Results All implantations of the second device were successful, resulting in elimination of the gradient (mean gradient 43.1 +/- 4.0 mm Hg before to 7.0 +/- 1.1 mm Hg after implantation). There was no final aortic regurgitation grade >= 2+. The extra-anatomically placed first prosthesis (ascending aorta, n = 8; abdominal aorta, n = 1) did not cause any clinical sequelae or gradients. During midterm follow-up, none of the 18 prostheses showed any sign of malfunction. Specifically, there were no signs of valve migration or of worsening paravalvular regurgitation. No case of valve thrombosis was documented. Conclusions A second CoreValve can be safely and effectively implanted in an in-series manner, without periprocedural complications. No problems arose on mid-term follow-up, ranging up to 20 months. (J Am Coll Cardiol Intv 2010;3:244-50) (C) 2010 by the American College of Cardiology Foundation