Valve sizing and implantation technique
Standard transcatheter devices used for valve-in-valve procedures were Edwards SAPIEN, SAPIEN XT and SAPIEN 3 (Edwards Lifesciences Inc., Irvine, CA. USA) as well as Medtronic CoreValve Evolut R (Medtronic, Minneapolis, MN, USA) and Symetis Accurate (Boston Scientific, Nattick, MA, USA). Choice of the valve depended on the individual surgeon’s preference and morphologic patterns of the failed bioprosthetic valve, e.g. the internal diameter.
Prior to the procedure, the internal diameter of the failed bioprostheses was determined from the manufacturer’s data. This represented the key parameter for sizing of the transcatheter devices. The internal diameter was intraoperatively additionally assessed by transesophageal echocardiography as well as measured prior in the CT-scan. The size choice of best transcatheter heart valve then based on the manufacturer’s recommendations, supported by the “ViV Aortic” App (supported by Minneapolis Heart institute Foundation and the Joseph F. and mary M. Fleischhacker Family Foundation; developed by Dr. Vinayak Bapat).
The procedure itself was performed like described previously [2, 3, 12]. For achieving an optimal hemodynamic result, a pronounced high position of the TAVR-prosthesis was aimed for [19].
Hemodynamics were evaluated by transthoracic echocardiography (TTE). Predischarge was defined as 6th postoperative day. Diagnostics during follow-up likewise were performed using TTE.