Transapical Implantation of a 2nd-Generation JenaValve Device in Patient with Extremely High Surgical Risk

Juan Mieres, Marcelo Menéndez, Carlos Fernández-Pereira, Miguel Rubio, Alfredo E Rodríguez, Juan Mieres, Marcelo Menéndez, Carlos Fernández-Pereira, Miguel Rubio, Alfredo E Rodríguez

Abstract

Transcatheter Aortic Valve Replacement (TAVR) is performed in patients who are poor surgical candidates. Many patients have inadequate femoral access, and alternative access sites have been used such as the transapical approach discussed in this paper. We present an elderly and fragile patient not suitable for surgery for unacceptable high risk, including poor ventricular function, previous myocardial infarction with percutaneous coronary intervention, pericardial effusion, and previous cardiac surgery with replacement of mechanical mitral valve. Transapical aortic valve replacement with a second-generation self-expanding JenaValve is performed. The JenaValve is a second-generation transapical TAVR valve consisting of a porcine root valve mounted on a low-profile nitinol stent. The valve is fully retrievable and repositionable. We discuss transapical access, implantation technique, and feasibility of valve implantation in this extremely high surgical risk patient.

Figures

Figure 1
Figure 1
Chest X-ray showing pleural effusion.
Figure 2
Figure 2
(a) Severe impairment of the left ventricular systolic function with pericardial effusion. (b) Severe aortic stenosis.
Figure 3
Figure 3
(a) 3D computer tomography images showing distance between aortic and mitral ring, (b) anterograde annulus entrance angles, and (c) place of transapical and 3D reconstruction of intercostal space site access.
Figure 4
Figure 4
Transapical access with a mini thoracotomy.
Figure 5
Figure 5
(a) Extra shift Amplatz 0,35 guide wire was deployed in descendent aorta to give extra backup support. (b) Aortic valvuloplasty with 22 mm balloon. ((c), (d)) A 32-French size delivery with its JenaValve device can be done, and a valve number 23 is implanted.
Figure 6
Figure 6
No residual valve leak, with mild valve gradient and an aortic valve area of 1.42 cm2 after implantation.
Figure 7
Figure 7
(a) Hospital discharge transthoracic ECHO showed a significant improvement of left ventricular EF, 41%, (b) 1.42 of aortic valve area and Vmax of 2.66.

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