89-Year-Old Woman Recovers Heart Health with Second TAVI Procedure

Recently, news broke about an 89-year-old female patient who regained her heart health through a second TAVI procedure. This patient, whose artificial heart valve implanted six years ago had narrowed again, opted for a new valve insertion using a catheter instead of undergoing open-heart surgery. The medical team at Seoul St. Mary's Hospital applied the LLAMACORN technique, which involves pre-cutting a thin membrane of the existing valve, to prevent the new valve from obstructing the coronary artery openings during deployment. This case marks the first TAVI re-procedure in Korea and offers hope to many.

The Importance of the Aortic Valve and TAVI Procedures

The aortic valve is a crucial gateway for blood flow from the heart to the rest of the body. When this valve becomes stiff and narrowed due to aging or other factors, the heart struggles to pump blood effectively, leading to various symptoms. These can include shortness of breath, chest pain, dizziness, and in severe cases, fainting. While traditional open-heart surgery to replace the damaged valve was common, TAVI offers a less invasive approach by inserting a new valve through a thin tube guided via the femoral artery, significantly reducing the burden for elderly patients or those at high surgical risk.

The Need for Re-procedures and the LLAMACORN Technique

However, artificial valves are not designed for indefinite use. Over time, the tissue can wear out or calcify, leading to re-narrowing. When a new valve is implanted inside the existing artificial valve, it's called a 'valve-in-valve' procedure. The patient in this case had undergone TAVI six years prior, but her valve had severely narrowed due to degenerative changes. The medical team determined that a new valve was necessary to ensure smooth blood flow.

• There's a risk that the leaflets of the existing valve could flip upwards and obstruct the coronary artery openings.
• The LLAMACORN technique addresses this by pre-cutting the existing valve leaflets to secure a pathway for blood flow.
• Using a self-expanding valve further reduces the risk of blocking the vascular openings.

Procedure Outcomes and Future Challenges

Following the implantation of the new valve, a transesophageal echocardiogram the day after the procedure showed that the peak velocity of blood flow across the aortic valve decreased from 4.6 m/s to 2.1 m/s, indicating that blood was flowing smoothly through the new valve. Professor Jang stated, "LLAMACORN is effective in securing blood flow pathways, and we are pleased to offer a new alternative for such patients."

However, TAVI procedures involve the use of expensive artificial valves, and patient costs can vary significantly depending on health insurance coverage. Currently, TAVI is covered by national health insurance only once. For subsequent re-procedures, the financial burden on patients can be substantial. With the increasing number of TAVI procedures performed on the elderly population, adjustments to health insurance guidelines for re-procedures seem necessary.

Over the past five years, Professor Jang's team at Seoul St. Mary's Hospital has recorded several 'first-in-Korea' procedure cases, including percutaneous inferior vena cava valve replacement, axillary artery access TAVI, the BASILICA technique, and transjugular aortic valve replacement, bringing hope to patients.