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Objectives: Transcatheter aortic valve-in-valve implantation (ViV) is a new treatment for failing bioprostheses (BP) in patients with high surgical risk. However, comparative data, using standard repeat surgical aortic valve replacement (redo-SAVR), are scarce. We compared outcomes after ViV with those after conventional redo-SAVR in two European centres with established interventional programmes., Methods: In-hospital databases were retrospectively screened for patients ≥60 years, treated for failing aortic BP. Cases of infective endocarditis or combined procedures were excluded. End-points were adjudicated according to the Valve Academic Research Consortium (VARC-2) criteria., Results: From 2002 to 2015, 130 patients were treated (ViV: n = 71, redo-SAVR: n = 59). Age and logistic EuroSCORE I scores were higher with ViV (78.6 ± 7.5 vs 72.9 ± 6.6 years, P < 0.01; 25.1 ± 18.9 vs 16.8 ± 9.3%, P < 0.01). The 30-day mortality rate was not significantly different (4.2 and 5.1%, respectively) (P = 1.0). Device success was achieved in 52.1% (ViV) and 91.5% (P < 0.01). No stroke was observed after ViV but in 3.4% after redo-SAVR (P = 0.2). Intensive care stay was longer after redo-SAVR (3.4 ± 2.9 vs 2.0 ± 1.8 days, P < 0.01). Mean transvalvular gradients were higher post-ViV (19.7 ± 7.7 vs12.2 ± 5.7 mmHg, P < 0.01), whereas the rate of permanent pacemaker implantation was lower (9.9 vs 25.4%, P < 0.01). Survival rates at 90 and180 days were 94.2 and 92.3% vs 92.8 and 92.8% (P = 0.87), respectively., Conclusions: Despite a higher risk profile in the ViV group, early mortality rates were not different compared with those of surgery. Although ViV resulted in elevated transvalvular gradients and therefore a lower rate of device success, mortality rates were similar to those with redo-SAVR. At present, both techniques serve as complementary approaches, and allow individualized patient care with excellent outcomes., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Indications for transcatheter valve implantation have been extended to treat native valve aortic regurgitation in case of disproportionate risk for open surgery. Transcatheter aortic valves are also an attractive alternative in patients who refuse blood transfusions. We report the successful off-label implantation of a self-expandable transcatheter valve in a Jehovah's Witness with prior replacement of the ascending aorta for Type A dissection, residual severe aortic regurgitation and refractory heart failure., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objectives: Swine models are widely used to develop new techniques and materials for the treatment of heart valve disease like aortic valve and mitral valve transcatheter interventions and to train physicians in these techniques. Transoesophageal echocardiography (TOE) is crucial in these models. We defined standard planes of 2D and 3D TOE in healthy pigs undergoing transcatheter heart valve interventions., Methods: Twenty healthy pigs (weight 56-106 kg) underwent different mitral and aortic valve interventions (transcatheter aortic valve implantations, implantations of a mitral band, bicuspidization of the aortic valve, trans-septal punctures). For image guidance of the procedures, an adult TOE probe was introduced under direct vision in the oesophagus. Before the procedure itself was performed, a standardized protocol was used to determine normal values for anatomical and functional echocardiographic parameters., Results: Positioning of the probe was possible in all animals and ideal when achieving a distance from the front teeth (incisors) of 40-60 cm. Anteflexion and lateroflexion of the probe was necessary to achieve optimal imaging quality. 2D visualization of all relevant cardiac structures was possible. The aortic annulus diameter was 24.1 ± 2.5 mm, the sinus of valsalva diameter was 30.6 ± 4 mm and the sinotubular junction diameter was 25.2 ± 4 mm. The ascending aorta had a diameter of 24 ± 4 mm and the descending aorta a diameter of 16 ± 5 mm. The mitral valve anterior-posterior diameter was 31.8 ± 4 mm and the commissure to commissure diameter was 40.5 ± 5 mm resulting in a mitral valve area of 10.7 ± 1.5 cm(2). 3D visualization was possible for the aortic and the mitral valve. None of the animals showed any pathology except one that had a dilated left ventricle and moderate mitral valve insufficiency. Left and right ventricular dimensions and the anatomy of the aortic-, mitral-, tricuspid and pulmonary valve as well as of the aorta were comparable with those of the human anatomy., Conclusions: 2D and 3D TOE can be routinely applied as image guidance in pigs used as a model for the development and training of new techniques to treat heart valve disease., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Some patients who underwent previous mitral valve surgery experience bioprosthetic valve degeneration or recurrent mitral valve regurgitation, and the transcatheter valve-in-valve or valve-in-ring procedure is a promising therapeutic option. Early thrombotic complications have been recently reported in 0.6-0.8% of TAVI prostheses implanted in aortic position. To the best of our knowledge, this article reports on the first case of thrombotic transcatheter mitral valve dysfunction which occurred on oral anticoagulation with Coumadin in combination with antiplatelet therapy. Although it is quite a rare complication, early thrombotic dysfunction of transcatheter valve prosthesis may occur., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Health care is a vital good for which there is an infinite demand. However, societal resources are finite and need to be distributed efficiently to avoid waste. Thus, the relative value of an intervention - cost compared to its effectiveness- needs to be taken into consideration when deciding which interventions to adopt. Cost-effectiveness analysis provides the crucial information which guides these decisions. As the field of medicine and indeed cardiology move forward with innovations which are effective but often expensive, it becomes imperative to employ these cost-effectiveness analytic tools, not with the intention of denying vital health services but to ascertain what the society willing to pay for.

The Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) transcatheter valve therapy (TVT) registry is a novel, national registry for all new TVT devices created through a partnership of the STS and the ACC in close collaboration with the Food and Drug Administration, the Center for Medicare and Medicaid Services, and the Duke Clinical Research Institute. The registry will serve as an objective, comprehensive, and scientifically based resource to improve the quality of patient care, to monitor the safety and effectiveness of TVT devices, to serve as an analytic resource for TVT research, and to enhance communication among key stakeholders., (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objective. To report the feasibility, safety and efficacy of percutaneous aortic valve implantation (PAVI) with the CoreValve self-expanding aortic valve bioprosthesis in elderly patients with aortic valve stenosis who are rejected for surgery or have a high surgical risk.Methods. PAVI using the CoreValve ReValving System was performed under general anaesthesia in 30 high-risk (surgical) patients with a symptomatic severe aortic valve stenosis.Results. The patients had a mean age of 80.5+/-7.7 years, a mean aortic valve area of 0.71+/-0.19 cm(2), a peak transvalvular aortic gradient of 79+/-25 mmHg, as measured with echo Doppler, a logistic EuroSCORE of 15+/-10% and a Society of Thoracic Surgeons (STS) score of 5.2+/-2.9%. Device success was achieved in all patients and acute procedural success in 27 patients (90%). In the surviving patients, there was in a reduction of the peak aortic pressure gradient from 76+/-24 mmHg to 22+/-7 mmHg (n=24, p<0.00001) 30 days after successful device implantation. At 30 days, major adverse cardiovascular and cerebral events had occurred in seven patients (23%). This included mortality in six patients (20%), of which one death was cardiovascular. The other five non-cardiovascular deaths involved two patients who died of an exacerbation of severe pre-existent pulmonary disease and three of infectious complications.Conclusions. Percutaneous aortic valve implantation was successfully performed in our centre in highrisk patients, with a 30-day mortality of 20%. When successful, marked haemodynamic improvement and relief of symptoms was achieved. (Neth Heart J 2010;18:18-24.).