How Far Out-of-Range Smaller SAPIEN 3 Ultra RESILIA Valve Implantation with Overfilling Is Acceptable?

抄録

Objective: The repeatability of transcatheter aortic valve implantation (TAVI) is an important issue for younger patients or patients with early structural valve deterioration (SVD) concerns.

Case Presentation: A 74-year-old female patient on hemodialysis (HD) visited our hospital for symptomatic severe aortic stenosis and difficulty of HD. She was at a high risk for open-heart surgery, and our heart team decided to perform TAVI. Pre-procedural electrocardiogram showed a complete right bundle branch block, and multidetector computed tomography (MDCT) revealed a low height of coronary artery and sinotubular junction and short membrane septum. Because she was on dialysis, we were concerned about early SVD, and implanting a 23-mm SAPIEN 3 Ultra RESILIA, which was suitable for her aortic annulus, would be a high risk for sinus sequestration in the future redo TAVI. Furthermore, she was at high risk for complete atrioventricular block, and implanting a transcatheter aortic valve (TAV) at a low position was not acceptable. So, we decided to select a 20-mm SAPIEN 3 Ultra RESILIA implanting overfilling with 2 ml. TAVI was performed with no complication, and post-procedural echocardiography revealed the TAV function was acceptable, and MDCT after TAVI showed suitable anatomy for redo TAVI.

Conclusion: We experienced a successful TAVI case with an out-of-range smaller SAPIEN 3 Ultra RESIRIA. An out-of-range smaller balloon-expandable valve might be a good choice if TAVI is required to be redone in the future.