Successful Treatment of Aortic Sutureless Valve Degeneration Using the Self-expandable Acurate Neo Percutaneous Prosthesis

Objective: We hereby describe successful implantation of the Boston Scientific (formerly Symetis) Acurate Neo TA transcatheter valve into a failed sutureless aortic bioprosthesis - LivaNova (formerly Sorin) Perceval S surgical valve. Methods: 80 year old female with history of aortic valve replacement 11 years ago with sutureless bioprosthesis Perceval S, size L due to severe aortic stenosis, had been admitted due to sharply decreasing exercise capacity. Echo assessment revealed severe degenerative changes of biological valve, transvalvular gradient (70/43mmHg), moderate regurgitation and 50% ejection fraction. Valve opening was 1.0-1.1cm2 with EOA index 0.6cm2/m2. Patient was consented for transcatheter treatment. Size was determined using the ViV application based on simulations and calculations. Due to narrow (5.5 and 5.0mm) severely calcified and tortuous femoral vessels, transapical access was preferred. Results: Left mini anterolateral thoracotomy in the 5ICS was carried out. LV apex was exposed, 2 3-0 pledgeted polypropylene sutures were used to secure puncture site. A 6F pigtail catheter was placed via right radial artery. The Acurate Neo delivery system (DS) was introduced into the ascending aorta over an extra stiff wire and aligned with the valve so the DS remained in line with the lowest visible margin of the Perceval stent. Comissural alingment was performed based on specific commissural markers present on the Perceval stent. Partial valve deployment followed, with release of the arches and upper crown of the Acurate Neo prosthesis to facilitate final valve release and completed the procedure. Conclusions: Implantation of the TAVR device into failed surgical bioprostheses (Valve-in-Valve; VIV) became a method of choice in treatment of bioprosthetic valve degeneration wherever surgical intervention is associated with increased risk of peri- and postoperative complications. Sutured surgical valves provide stable platform for TAVR, which can be anchored into preexisting metal or plastic stent (or frame), without risk of dislodgment. KEYWORD: e-PD-64 The authors do not declare any conflict of interest.