Interdisciplinary cardiovascular and thoracic surgery · 2026
Breaking the Limits: Transcarotid Valve-in-Valve Transcatheter Aortic Valve Implantation With Bioprosthetic Valve Fracture in a Small Mitroflow and Extracorporeal Membrane Oxygenation Rescue.
СтатьяКлинический случайНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Mosquera Víctor X, Martinez-Comendador José M, Cuenca-Castillo José J
Аннотация
BACKGROUND: Valve-in-valve transcatheter aortic valve implantation (ViV TAVI) in small surgical bioprostheses presents unique challenges due to high residual gradients and risk of coronary obstruction.
CASE SUMMARY: We report a case of an 86-year-old man with a degenerated Mitroflow 19 mm valve who underwent ViV TAVI via transcarotid access using a 20 mm Myval valve. Significant underexpansion was observed post-implantation, with elevated transvalvular gradients. Bioprosthetic valve fracture (BVF) was performed using an 18 mm non-compliant balloon, resulting in full valve expansion and gradient reduction. Shortly after BVF, the patient developed myocardial stunning and hemodynamic collapse, requiring urgent veno-arterial extracorporeal membrane oxygenation (VA ECMO) support. Extracorporeal membrane oxygenation was successfully weaned after 48 hours, and the patient was discharged in stable condition.
CONCLUSION: This is the first reported case of transcarotid ViV TAVI with BVF in a 19 mm Mitroflow bioprosthesis, successfully rescued with ECMO. The report highlights the importance of appropriate access planning, valve selection, and ECMO standby in complex high-risk anatomies.
CASE SUMMARY: We report a case of an 86-year-old man with a degenerated Mitroflow 19 mm valve who underwent ViV TAVI via transcarotid access using a 20 mm Myval valve. Significant underexpansion was observed post-implantation, with elevated transvalvular gradients. Bioprosthetic valve fracture (BVF) was performed using an 18 mm non-compliant balloon, resulting in full valve expansion and gradient reduction. Shortly after BVF, the patient developed myocardial stunning and hemodynamic collapse, requiring urgent veno-arterial extracorporeal membrane oxygenation (VA ECMO) support. Extracorporeal membrane oxygenation was successfully weaned after 48 hours, and the patient was discharged in stable condition.
CONCLUSION: This is the first reported case of transcarotid ViV TAVI with BVF in a 19 mm Mitroflow bioprosthesis, successfully rescued with ECMO. The report highlights the importance of appropriate access planning, valve selection, and ECMO standby in complex high-risk anatomies.