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Case Reports
. 2021 Dec 1;3(17):1806-1810.
doi: 10.1016/j.jaccas.2021.08.026.

First Transfemoral Implantation of a Novel Transcatheter Valve in an LVAD Patient With Aortic Insufficiency

Lauren S Ranard  1 , Ryan Kaple  2 , Omar K Khalique  1 , Vratika Agarwal  2 , Lavanya Bellumkonda  2 , Pramod Bonde  2 , Isaac George  1 , Nir Uriel  1 , Martin B Leon  1 , Torsten P Vahl  1
Affiliations
Case Reports

First Transfemoral Implantation of a Novel Transcatheter Valve in an LVAD Patient With Aortic Insufficiency

Lauren S Ranard et al. JACC Case Rep. .

Abstract

An 80-year-old man with a destination left ventricular assist device (LVAD) presented with decompensated heart failure. Evaluation demonstrated numerous LVAD high power spike events, significant aortic regurgitation, and hemolysis. He underwent successful aortic valve replacement with a novel transcatheter valve and LVAD pump exchange that resulted in an improvement in his clinical status. (Level of Difficulty: Advanced.).

Keywords: AR, aortic regurgitation; CO, cardiac output; CTA, computed tomography angiography; LVAD, left ventricular assist device; LVEDD, left ventricular end diastolic dimension; NYHA, New York Heart Association; PA, pulmonary artery; PCWP, pulmonary capillary wedge pressure; RA, right atrial; RV, right ventricular; TAVR; TAVR, transcatheter aortic valve replacement; TEE, transesophageal echocardiogram; THV, transcatheter heart valve; TTE, transthoracic echocardiogram; aortic regurgitation.

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Conflict of interest statement

Dr Khalique is part of a core laboratory contracting with JenaValve but has not received any direct compensation; has received consulting fees from Abbott Structural and Boston Scientific; and has received Speakers Bureau fees from Edwards Lifesciences. Dr George has received consulting fees from Cardiomech, Mitremedical, Atricure, Vdyne, Valcare Medical, DurVena, MITRx, and Johnson & Johnson. Dr Leon has reported institutional clinical research grants from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, and JenaValve. Dr Vahl has reported institutional funding to Columbia University Irving Medical Center from Boston Scientific, Edwards Lifesciences, JenaValve, Medtronic, and Siemens Healthineers; and has received consulting fees from Abbott Vascular, Boston Scientific, and Siemens Healthineers. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Left Ventricular Assist Device Device Evaluation Device evaluation demonstrated numerous high-power alarms (examples indicated by blue arrows).
Figure 2
Figure 2
JenaValve Trilogy Transcatheter Heart Valve System The valve consists of a nitinol frame with porcine pericardial leaflets. The delivery system has a deflector that allows for coaxial alignment and a controller knob that facilitates axial rotation of the valve to align the radiopaque locators in the middle of each coronary cusp.
Figure 3
Figure 3
Preprocedural Cardiac Computed Tomography Angiography Analysis Preprocedural cardiac computed tomography angiography demonstrated an annulus perimeter of 82.9 mm, corresponding to a 27-mm valve. The aortic angulation was 50° with adequate distance to the ascending aorta. LM = left main [coronary artery]; RCA = right coronary artery; VAD = ventricular assist device.
See this image and copyright information in PMC

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