How should I treat dislocation of a TAVI SAPIEN prosthesis into the left ventricle?

Background: Despite the technical advancements of the transcatheter aortic valve implantation (TAVI) procedure, valve embolisation into the left ventricle remains a challenging situation requiring expedited management through the Heart Team.

Investigation: The advantages and pitfalls of an interventional transfemoral approach, a transapical extraction of the dislocated prosthesis or the conversion to open heart surgery have to be balanced depending on the overall situation and the specific characteristics of the patient.

Diagnosis: A transfemoral approach would be the first choice for most TAVI implanters.

Transcatheter aortic valve implantation in patients with severely reduced left ventricular systolic function: a single-center experience.

Aims: Current guidelines consider severe systolic left ventricular dysfunction [ejection fraction (EF) ≤20 %; left ventricular dysfunction (LVD)] a contraindication for transcatheter aortic valve implantation (TAVI). The purpose of this study was to evaluate the efficacy and safety of TAVI in this extreme risk subset of patients.

Methods And Results: The study population (253 patients) was divided into two groups; the LVD group [21 patients with left ventricular ejection fraction (LVEF) ≤20 %] and the control group (232 patients with LVEF >20 %).

Mid-term results of different aortic valve-sparing procedures in Marfan syndrome.

Background And Aim Of The Study: Marfan patients with aortic root aneurysm are typically treated with the Bentall procedure, though aortic valve-sparing procedures (AVSPs) are also possible. The study aim was to compare the authors' experience with two such techniques performed at their institution, namely a reimplantation according to David (David I) and remodeling according to Yacoub.

Methods: Between 1996 and 2009, a total of 37 Marfan patients underwent an AVSP at the authors' institution.

Non-invasive cerebral oxygenation reflects mixed venous oxygen saturation during the varying haemodynamic conditions in patients undergoing transapical transcatheter aortic valve implantation.

Transapical transcatheter aortic valve implantation (TA-TAVI) is increasingly used to treat aortic valve stenosis in high-risk patients. Mixed venous oxygen saturation (SvO(2)) is still the 'gold standard' for the determination of the systemic oxygen delivery to consumption ratio in cardiac surgery patients. Recent data suggest that regional cerebral oxygen saturation (rScO(2)) determined by near-infrared spectroscopy is closely related to SvO(2).

Altered microRNAs in bicuspid aortic valve: a comparison between stenotic and insufficient valves.

Background And Aim Of The Study: Bicuspid aortic valve (BAV), the most common form of congenital heart disease, is a leading cause of aortic stenosis (AS) and aortic insufficiency (AI). AS is typically caused by calcific valve disease. Recently, microRNAs (miRNAs) have been shown to modulate gene expression.

Percutaneous aortic valve replacement: overview and suggestions for anesthestic management.

Transcutaneous aortic valve replacement (AVR) is increasingly used for high-risk patients with severe aortic stenosis, who have high operative mortality for surgical placement during cardiopulmonary bypass (CPB). Retrograde transfemoral AVR is usually performed during sedation, whereas antegrade transapical AVR is done with general anesthesia. Both procedures can be carried out without CPB.

The association of non-invasive cerebral and mixed venous oxygen saturation during cardiopulmonary resuscitation.

Mixed venous oxygen saturation (SvO(2)) is an accepted surrogate parameter for the ratio between oxygen delivery and demand and may thus be used to determine the adequacy of the function of the cardiopulmonary system. Cerebral oxygen saturation monitoring by near infrared spectroscopy is a non-invasive method for the determination of the cerebral oxygen delivery to demand ratio that is applicable outside the operating room or the intensive care unit and does not require calibration. The present case highlights the agreement of non-invasive cerebral and SvO(2) in an 87-year-old female cardiac surgery patient with severe aortic stenosis scheduled for transapical aortic valve replacement during prolonged cardiopulmonary resuscitation.