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J Thorac Cardiovasc Surg 2008;136:697-701
© 2008 The American Association for Thoracic Surgery

Evolving Technology

Surgical aortic valve replacement after percutaneous aortic valve implantation: What have we learned?

Pierre-Yves Litzler, MDa,*, Alain Cribier, MDb, Alan Zajarias, MDb, Diane Comte, MDa, Hélène Eltchaninoff, MDb, Christophe Tron, MDb, Catherine Haas-Hubscher, MDc, Jean-Paul Bessou, MDa

a Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital Charles Nicolle, Rouen, France
b Department of Cardiology, Rouen University Hospital Charles Nicolle, Rouen, France
c Department of Anaesthesiology, Rouen University Hospital Charles Nicolle, Rouen, France

Received for publication December 5, 2007; accepted for publication December 24, 2007.

* Address for reprints: Pierre-Yves Litzler, MD, Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, 1, rue de Germont, 76000 Rouen, France. (Email: pierre-yves.litzler{at}chu-rouen.fr).

Objective: We report the first case description of surgical aortic valve replacement after percutaneous valve implantation.

Methods: An 87-year-old man with severe aortic stenosis who was rejected for surgical intervention underwent percutaneous valve implantation through a retrograde femoral approach. The procedure was complicated by cardiogenic shock caused by severe aortic insufficiency, leading to emergency surgical aortic valve replacement.

Results: The operative findings revealed the presence of commissural paravalvular leaks and centrally malapposed leaflets. Surgical replacement was uneventful, and the patient was discharged on day 30, despite a challenging postoperative course. His follow-up at 1 year has been uneventful. This case illustrates that overdilatation of the stent is not recommended because it might worsen central aortic insufficiency. Moreover, the transapical route should be considered when the appropriately sized prosthesis is unable to be inserted because of inappropriate vascular access. However, despite an initial "prohibitive" surgical risk, surgical aortic valvular replacement after percutaneous valve implantation could be easily performed.

Conclusion: Percutaneous heart valve implantation, which provides a larger surface area than balloon valvotomy, can be offered to patients with cardiogenic shock and severe comorbidities to improve their hemodynamic state and reduce their surgical risk.

Abbreviations and Acronyms LVEF = left ventricular ejection fraction; PHC = percutaneous heart valve






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