Wrinkles, folds and calcifications: Reduced durability after transcatheter aortic valve-in- valve replacement Herko Grubitzsch, MD, PhD, Marco Galloni,

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Presentation transcript:

Wrinkles, folds and calcifications: Reduced durability after transcatheter aortic valve-in- valve replacement Herko Grubitzsch, MD, PhD, Marco Galloni, MSc, Volkmar Falk, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 153, Issue 2, Pages 266-268 (February 2017) DOI: 10.1016/j.jtcvs.2016.08.018 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Early structural failure after transcatheter aortic valve-in-valve replacement. A, Section of patient's chest radiograph showing a 23-mm CoreValve transcatheter valve (Medtronic, Minneapolis, Minn) within a 21-mm Mitroflow conventional stented bioprosthesis (LivaNova PLC, London, United Kingdom). B, The explanted CoreValve-Mitroflow-corpus presenting pericardial folds and vegetating calcifications at the outflow aspects. C, Wrinkled pericardium and calcifications at the inflow aspect of the explanted CoreValve prosthesis. D, Radiographic examination demonstrates an ovalized, noncircular cross-sectional profile of the transcatheter valve within the stented bioprosthesis, as well as multiple calcifications at all leaflets of the CoreValve prosthesis. E, Alizarin red staining of a leaflet fold with intrinsic calcium nodule (3-fold magnification). F, Hematoxylin-eosin staining of a leaflet fold showing homogenized and locally disrupted collagen bundles, a bubbly tissue texture, and pericardial delamination (20-fold magnification). The Journal of Thoracic and Cardiovascular Surgery 2017 153, 266-268DOI: (10.1016/j.jtcvs.2016.08.018) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Incomplete expansion and calcification after transcatheter valve-in-valve replacement. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 266-268DOI: (10.1016/j.jtcvs.2016.08.018) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Video 1 Fluoroscopy demonstrating the degenerated 21-mm Mitroflow prosthesis (LivaNova PLC, London, United Kingdom) and the valve-in-valve procedure with a 23-mm CoreValve prosthesis (Medtronic, Minneapolis, Minn). Video available at: http://www.jtcvsonline.org/article/S0022-5223(16)31037-6/addons. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 266-268DOI: (10.1016/j.jtcvs.2016.08.018) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions