Three mechanisms of early failure of transcatheter aortic valves: Valve thrombosis, cusp rupture, and accelerated calcification Matthew R. Summers, MD,

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Presentation transcript:

Three mechanisms of early failure of transcatheter aortic valves: Valve thrombosis, cusp rupture, and accelerated calcification Matthew R. Summers, MD, Paul C. Cremer, MD, Wael A. Jaber, MD The Journal of Thoracic and Cardiovascular Surgery Volume 153, Issue 5, Pages e87-e93 (May 2017) DOI: 10.1016/j.jtcvs.2016.12.011 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 TTE showing 0.8 × 0.5-cm supravalvular thrombus (yellow arrow) on bioprosthetic SAPIEN XT (Edwards Lifesciences, Irvine, Calif) valve in parasternal short-axis view (A). TTE with color Doppler during diastole in apical long-axis view demonstrating associated aortic insufficiency (B). TTE with continuous-wave Doppler in apical long-axis view demonstrating mild-moderate aortic insufficiency and increased velocity across the valve (C, peak velocity of 3.3 m/s and peak and mean gradients of 42 and 22 mm Hg, respectively). Correlative TTE images from 1 year previously (3 years post-TAVR) demonstrating the lack of thrombus, valve dysfunction, and lower transvalvular peak velocity and gradients (D-F). The Journal of Thoracic and Cardiovascular Surgery 2017 153, e87-e93DOI: (10.1016/j.jtcvs.2016.12.011) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 TTE showing only mild valve thickening, but flail leaflet in parasternal long-axis (A), parasternal short-axis (B), and apical long-axis (C) views. Correlative TTE Doppler views demonstrating severe prosthetic transvalvular regurgitation (D, E). Continuous-wave Doppler demonstrating severe prosthetic valvular insufficiency (F). The Journal of Thoracic and Cardiovascular Surgery 2017 153, e87-e93DOI: (10.1016/j.jtcvs.2016.12.011) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 TTE showing severe valve thickening and degeneration in parasternal long-axis (A) and parasternal short-axis (D) views. Associated severe aortic insufficiency demonstrated by color Doppler in apical long-axis (B, C) and parasternal short-axis (E) views. Continuous-wave Doppler demonstrating severe aortic insufficiency (F). The Journal of Thoracic and Cardiovascular Surgery 2017 153, e87-e93DOI: (10.1016/j.jtcvs.2016.12.011) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

TTE of a distinct mechanism of early TAVR failure: thrombosis. The Journal of Thoracic and Cardiovascular Surgery 2017 153, e87-e93DOI: (10.1016/j.jtcvs.2016.12.011) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Video 1 TTE demonstrating 0.8 × 0.5-cm supravalvular thrombus (yellow arrow) on bioprosthetic SAPIEN XT (Edwards Lifesciences, Irvine, Calif) valve in parasternal short-axis (A) and apical long-axis (C) views. Associated prosthetic valvular insufficiency seen by color Doppler in parasternal short-axis (B) and apical long-axis (D) views. Video available at: http://www.jtcvsonline.org/article/S0022-5223(16)31676-2/addons. The Journal of Thoracic and Cardiovascular Surgery 2017 153, e87-e93DOI: (10.1016/j.jtcvs.2016.12.011) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Video 2 TTE showing only mild valve thickening, with cusp rupture and flail leaflet in parasternal long-axis (A), apical long-axis (C) and parasternal short-axis (E) views. Correlative TTE color Doppler views demonstrating severe prosthetic valvular insufficiency (B, D, F). Video available at: http://www.jtcvsonline.org/article/S0022-5223(16)31676-2/addons. The Journal of Thoracic and Cardiovascular Surgery 2017 153, e87-e93DOI: (10.1016/j.jtcvs.2016.12.011) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Video 3 TTE showing severe valve thickening and degeneration in apical long-axis views (A, C) and parasternal short-axis view (E). Correlative color Doppler demonstrating severe aortic insufficiency (B, D, F). Video available at: http://www.jtcvsonline.org/article/S0022-5223(16)31676-2/addons. The Journal of Thoracic and Cardiovascular Surgery 2017 153, e87-e93DOI: (10.1016/j.jtcvs.2016.12.011) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions