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Introduction: Transcatheter aortic valve implantation/replacement (TAVI or TAVR) has been established as a first line therapy in patients with symptomatic severe aortic stenosis (AS) at high or prohibitive surgical risk and as an alternative in elderly patients with intermediate surgical risk. Since its first-in-human procedure in 2002, the past 15-years have shown rapid developments in TAVI technology with the introduction and further improvement of new transcatheter heart valves (THV). Areas covered: There are currently several THV systems available, based on balloon-expandable, self-expandable or other technologies. Some of these are repositionable and retrievable even after partial or full deployment, potentially reducing the risk of malpositioning. The aim of this review is to describe such repositionable self-expandable THV systems. Expert commentary: Repositionability potentially represents a crucial step towards higher safety and efficacy of TAVI. It is unclear if full self-expandability or a combination of self and mechanical expansion will be more advantageous. [ABSTRACT FROM AUTHOR]

BACKGROUND: No retrievable and repositionable second generation transcatheter aortic valve is available in China. Here, we report the first-in-man implantation of the retrievable and repositionable VenusA-Plus valve. METHODS: A 76-year-old patient with symptomatic severe aortic stenosis and high surgical risk (STS 13.8%) was recommended for transcatheter aortic valve replacement (TAVR) by heart valve team. Type 0 bicuspid aortic valve with asymmetric calcification was identified by dual source computed tomography, and the unfavorable anatomies increased the possibility of malposition and paravalvular leakage during TAVR. Therefore, we used the retrievable and repositionable VenusAPlus valve for the patient. RESULTS: Transfemoral TAVR was performed under local anesthesia with sedation, and a 26mm VenusA-Plus valve was successfully implanted. No transvalvular pressure gradient and trace paravalvular leakage were found. CONCLUSION: The successful first-in-man implantation indicates the retrievable and repositionable VenusA-Plus valve is feasible in complicated TAVR cases such as bicuspid aortic valve. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve implantation (TAVI) is a great alternative treatment option in high surgical risk and inoperable patients with severe symptomatic aortic stenosis (AS). TAVI is a rapidly emerging technique with a constantly expanding body of evidence. However, the devices, which are commercially available and are currently used widely, have several major limitations. In particular, the inability to reposition/ retrieve/resheath valves, in addition to several patient selection and procedural limitations, such as the occurrence of moderate to severe paravalvular regurgitation (PVR), the risk of annular rupture, atrioventricular (AV) conduction abnormalities with subsequent pacemaker requirement, vascular complications and associated bleeding, coronary ostial obstruction by the valve, stroke, as well as complex delivery processes, are expected to be overcome with the newer generation valves. Consequently, a number of new transcatheter valve choices have been developed either for clinical study or are in the pipeline, that it is hoped to bring meaningful clinical outcomes compared with the currently commercially available technology. Early data on design modifications have shown significant reductions in adverse outcomes from TAVI. [ABSTRACT FROM AUTHOR]

Background: Anastomotic leakages are severe complications of upper gastrointestinal surgery with serious morbidity and mortality. Until recently, only abscess drainage was possible. Since 2007, removable and repositionable covered metal self-expandable stents (RReCoMSeS) have been used in our hospital to cover leaks. Methods: Patients with postsurgical gastrointestinal leaks treated with RReCoMSeS between January 2007 and March 2010 were retrospectively evaluated and described. Results: Twenty-six patients were treated with RReCoMSeS (totally covered Choo/Hanaro and partially covered Endoflex stents). Included patients had anastomotic leaks after esophagectomy (15) and bariatric surgery (11). Overall successful sealing of the leak occurred in 81 % (including multiple procedures). In total 33 RReCoMSeS were used (mean 1.3 stents and 1.7 procedures per patient). Twenty-one of 33 RReCoMSeS succeeded in sealing the leak (64 %). Migration occurred in 24 % RReCoMSeS, and 9 % disintegrated. One stent (3 %) caused a perforation. Conclusions: RReCoMSeS are a safe alternative for treating postsurgical leaks in the upper gastrointestinal tract. In 81 % of patients and with 64 % of the inserted stents, leaks were sealed successfully, with few complications. Fewer stents per patient were needed thanks to their repositionability. Stent migration is a major problem. [ABSTRACT FROM AUTHOR]

Introduction: Years after mitral valve surgery, progressive degeneration of reconstructed mitral valves or bioprostheses might lead to severe mitral valve regurgitation. Patients with significant comorbidity, or impaired left ventricular function are poor candidates for redo surgery at an acceptable risk at that later time point., Methods and Results: This study reports the first-in-man transapical valve-in-ring implantations in the mitral position of the fully repositionable Lotus valve system approved for transcatheter aortic valve replacement in Europe. Transapical valve-in-ring implantations with this valve system were successfully performed in a 64-year-old female, and a 53-year-old male patient. Both patients were NHYA class IV, and carried an unacceptably high risk of cardiac surgery due to clinical condition and comorbidity. The first patient was successfully implanted a 25 mm valve, improved to NYHA class II, and was discharged 2 weeks after the procedure. The second patient required a short episode of cardiopulmonary resuscitation after valve implantation (27 mm), and was placed on veno-venous ECMO for 24 hr to improve oxygenation. He developed stroke on day 7, and deceased from fatal, toxic rhabdomyolysis 13 days after the procedure., Conclusion: Transapical valve-in-ring implantation of the repositionable Lotus valve system in the mitral position is a feasible and promising option that merits further evaluation. © 2015 Wiley Periodicals, Inc., (© 2015 Wiley Periodicals, Inc.)

Abstract: Introduction: A case of abdominal aortic aneurysm (AAA), treated with a repositionable stent-graft, in the presence of bilateral common iliac stents positioned partially within the aneurysm is presented. Case report: An 84 year-old man had endovascular repair of a 55 mm AAA. Bilateral common iliac stents, which had been implanted 14 years previously for iliac occlusive disease, were partially positioned within the aneurysm. Endovascular repair required partial device deployment above the aneurysm to enable contralateral limb cannulation. The stent graft was then positioned correctly and fully deployed. Discussion: This case highlighted the utility of a stent-graft with a repositionable delivery system. [Copyright &y& Elsevier]

While transcatheter aortic valve replacement (TAVR) is an accepted treatment modality in appropriately selected patients there remain modest complication rates. New TAVR devices, through novel design features, may overcome some of these complications. We present the first case of full re-sheathing and retrieval of a Lotus Valve to facilitate a change in prosthesis size., (Copyright © 2013 Wiley Periodicals, Inc.)