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Simultaneous transcatheter aortic valve implantation and drive-by endovascular aortic aneurysm repair: a case of lotus valve retrieved and replaced due to an undersized valve after an endovascular aneurysm repair

  • Hashrul N. RashidEmail author
  • Liam M. McCormick
  • Robert P. Gooley
  • Ian T. Meredith
Case Report

Abstract

A 79-year-old man with stable chronic obstructive pulmonary disease was found to have an abdominal aortic aneurysm and worsening dyspnoea. Echocardiography demonstrated critical aortic stenosis. Simultaneous endovascular aneurysm repair (EVAR) and transcatheter aortic valve replacement (TAVR) was recommended due to high surgical risk. Procedural strategy was to perform balloon valvuloplasty (BAV), followed by EVAR then TAVR. The initial 25 mm Lotus valve adopted a barrel shape suggestive of an undersized valve and was thus replaced with a 27 mm valve. Post procedural echo revealed no regurgitation. We report here for the first time a successful simultaneous TAVR/EVAR using the fully retrievable Lotus Valve.

Keywords

TAVR TAVI Aortic stenosis EVAR Lotus valve 

Notes

Compliance with ethical standards

Conflict of interest

There was no funding provided for this case report. Prof. Ian T Meredith has received consultant fees and honoraria from Boston Scientific and Medtronic and proctor fees from Boston Scientific. Dr Robert Gooley receives proctor fees from Boston Scientific.

Supplementary material

Video 1; 25mm LotusTM delivery system was passed easily through the EVAR stents (mp4 795 kb)

Video 2; Aortography revealing no paravalvular regurgitation (mp4 1284 kb)

References

  1. 1.
    Nguyen V, Cimadevilla C, Estellat C, Codogno I, Huart V, Benessiano J, et al. Haemodynamic and anatomic progression of aortic stenosis. Hear [Internet]. 2015;101(12):943–7.CrossRefGoogle Scholar
  2. 2.
    Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370(19):1790–8. doi: 10.1056/NEJMoa1400590.CrossRefPubMedGoogle Scholar
  3. 3.
    Kurra V, Schoenhagen P, Roselli EE, Kapadia SR, Tuzcu EM, Greenberg R, et al. Prevalence of significant peripheral artery disease in patients evaluated for percutaneous aortic valve insertion: preprocedural assessment with multidetector computed tomography. J Thorac Cardiovasc Surg. 2009;137(5):1258–64.CrossRefPubMedGoogle Scholar
  4. 4.
    Drury-Smith M, Garnham A, Khogali S. Critical aortic stenosis in a patient with a large saccular abdominal aortic aneurysm. Catheter Cardiovasc Interv. 2012;80(6):1014–8. doi: 10.1002/ccd.23452.CrossRefPubMedGoogle Scholar
  5. 5.
    Yanes-Bowden G, Bosa-Ojeda F, del Castro-Madrazo JA, Laynez-Cerden I, Vargas-Torresa MJ. Flecha AS-G. Subclinical coronary atherosclerosis identified by coronary computed tomography angiography in asymptomatic population by coronary artery disease risk level. Rev Esp Cardiol. 2013;66(6):504–5.CrossRefGoogle Scholar
  6. 6.
    Kawashima H, Watanabe Y, Kozuma K. Successful transfemoral aortic valve implantation through aortic stent graft after endovascular repair of abdominal aortic aneurysm. Cardiovasc Interv Ther. 2016;1–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26946291.
  7. 7.
    Aluko Y, Diehl L, Jacoby R, Chan B, Andrews S, McMillan E, et al. Simultaneous transcatheter aortic valve replacement and endovascular repair for critical aortic stenosis and large abdominal aortic aneurysm. Cardiovasc Revascul Med. 2015;16(4):254–8.CrossRefGoogle Scholar
  8. 8.
    Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, De Hert S, et al. 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management. Eur Heart J. 2014;35(35):2344–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Eltchaninoff H, Durand E, Borz B, Furuta A, Bejar K, Canville A, et al. Balloon aortic valvuloplasty in the era of transcatheter aortic valve replacement: acute and long-term outcomes. Am Heart J. 2014;167(2):235–40. doi: 10.1016/j.ahj.2013.10.019.CrossRefPubMedGoogle Scholar
  10. 10.
    Grasso AW, Jaber WA. Risk stratification for noncardiac surgery. Cleveland Clinic. 2014. Available from: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/cardiac-risk-stratification-for-noncardiac-surgery/.
  11. 11.
    Biernawska J, Kaczmarczyk M, Kotfis K, Cnotliwy M, Zegan-Barańska M, Zukowska A, et al. Electrophysiological, hemodynamic, and metabolic response to open procedure or endovascular repair of infrarenal aortic aneurysms. Ann Vasc Surg. 2014;28(7):1659–64.CrossRefPubMedGoogle Scholar
  12. 12.
    Rylski B, Szeto WY, Bavaria JE, Emanuela Branchetti WMA, Milewski RK. Development of a single endovascular device for aortic valve replacement and ascending aortic repair. J Card Surg. 2014;29:371–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Dewey TM, Brown DL, Herbert MA, Culica D, Smith CR, Leon MB, et al. Effect of concomitant coronary artery disease on procedural and late outcomes of transcatheter aortic valve implantation. Ann Thorac Surg. 2010;89(3):758–67. doi: 10.1016/j.athoracsur.2009.12.033.CrossRefPubMedGoogle Scholar
  14. 14.
    Stefanini GG, Stortecky S, Cao D, Rat-Wirtzler J, O’Sullivan CJ, Gloekler S, et al. Coronary artery disease severity and aortic stenosis: clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation. Eur Heart J. 2014;35(37):2530–40.CrossRefPubMedGoogle Scholar
  15. 15.
    Meredith IT, Hood KL, Haratani N, Allocco DJ, Dawkins KD. Boston scientific lotus valve. Euro Interv. 2012;8:Q70–4.Google Scholar

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2016

Authors and Affiliations

  • Hashrul N. Rashid
    • 1
    • 2
    Email author
  • Liam M. McCormick
    • 1
    • 2
  • Robert P. Gooley
    • 1
    • 2
  • Ian T. Meredith
    • 1
    • 2
  1. 1.MonashHeart, Monash HealthMelbourneAustralia
  2. 2.Monash Cardiovascular Research CentreMonash UniversityMelbourneAustralia

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