Euro Clinic

Yes, thank you very much. Thank you for kind invitation. Once again, I would Why we do more and more of valve-in-valve? Because the use of bioprosthetic valve increase, because the operative mortality increase more than 30 percent in We know predictors for early tissue valve failure. These are a young age, renal failure and valve type. And of course, the most common reasons were endear, classification, panus, endocarditis, and thrombus. And let'see our case. T Zaharulis two years ago. T She had a single CABG, lima to LAD, and one self-expandable supranular sutures, bioprosthetic valve, perceval valve large size. She was in medical background with hypertension, dysentery, And the resource for referral is recent also in C We have some clinical findings. These are the medical treatment with a blocker, statins, and a big sabon. T And according to the sanotubular junction, these are the sizes, small, medi It is important to know how these valves we can see on fluoroscopy and what are the markers of these valves and why they use the surgeon's valves. Because it's a minimal invasive approach because they have short duration of cross-clamp because prevent patients' processes mismatch, allow a larger effective orifice area, and because it's an ideal solution for elderly people with small anulus. Back to our patient. We have elevated anti-pro-BMP. We have pulmonary congestion from the chest x-ray and from echocardiography. We saw a significant failure of bioprosthetic valve with peak velocity six metres per second in our tick position. We performed coronary radiography and we saw also that this lady had two vessels' disease, 80% in mid-RCA and 80% in mid-circ The Euro score was 15 and the heart team in our hospital decided to proceed with the valve-in-valve. The next step is we decided to do two steps, management. First we done the PCI at RCA and then the PCI and the circ We performed the CT scan, the trimation and we saw good femoral arteries. The height of the coronary was quite good and the valve that we are choosing was the accurate NEO, the large size. The ideal placement will be in line with the lowest visible margin of the perceivable valve stand as you can see in the right picture. We start the procedure, the transfer molar axis. We are pre-dalatation with the balloon atlas and then we implant the accurate NEO exactly at the position that we set. The follow-up of our patient is quite good. Three days hospitalization and then discharge. The residual mean gradient was below 20 mm per mercury and we follow two years follow-up of our patient. We see without the symptoms the valve is quite good and peak and the maxim We have data for valve-in-valve, early and midterm with good result versus redo SARV. We have less mortality and stroke in valve-in-valve. Metanalysis in one year we have less mortality in valve-in-valve. For balloon-expandable valve we have better results versus redo SARV in all complications and also in balloon-expandable valves. Regarding the two supra-annual valves that we have, the accurate and the evolved, we have similar procedural and clinical outcomes according to the average registry. So the only question that we have is the durability and we need long-term data to answer thank you very much for your attention. Congratulations Kostas and I also forgot to congratulate you on your new position in the University of Thrace. May you prosper there? Any comments from the panel? Actually it's a very nice case and such a pity for t And I t My question is, did you try to see if you could actually cannulate the osteo-after the valve-in-valve procedure? No, but thank you. Dr. Gabriel Lados, congratulations Kostas. I noticed that you did the pre-dialetation and you carefully implanted the valve. Do you usually do the post-dialetation in order to get a better alignment? Not in all cases. Inversible not. If it was a trifecta? Yes, perhaps. Great job on the price as well. If there's going to be a need for a t But the lady is nine years old now. Kostas, congratulations. I don't know what it goes immediately post-procedure, but you t It's acceptable, but it has a large principle before hand. I don't know how it was the base gradient, the IED gradient when it was implanted. I don't know how much was the gradient immediately after your procedure. Because if we have now three meters, that is a harbinger of not good news. At the beginning, the velocity was six meters per second. After the procedure was 2. 7, 2. 6, something And two years ago, it's three. I thank you, Kostas. It's acceptable what one can do, what they can't do. You can do better.