A valve is a gate-like tissue inside the heart or blood vessels that prevents blood from flowing backward. An 89-year-old patient whose artificial heart valve failed once again can now receive a new valve without opening the chest. A next-generation procedure that lowers the risk of coronary blockage that can occur due to a damaged heart valve has been successfully performed for the first time in Korea by a medical team at The Catholic Univ. of Korea Seoul St. Mary's Hospital.
The team led by Professor Jang Gi-yuk at the Heart, Brain and Vascular Hospital of The Catholic Univ. of Korea Seoul St. Mary's Hospital said on the 29th that on the 22nd it performed Korea's first valve-in-valve TAVI redo using the "LLAMACORN" technique on an 89-year-old female patient whose previous transcatheter aortic valve implantation (TAVI) valve was damaged.
TAVI is a treatment that replaces a narrowed aortic valve with an artificial valve using a catheter (medical tube) without opening the chest. It is widely used for older patients or those at high surgical risk, but the implanted artificial valve can also lose function over time due to degenerative changes.
In this case, a "valve-in-valve procedure" is performed by inserting a new valve inside the existing valve. However, there is a risk that the existing valve leaflets (valve tissue), pushed up by the new valve, may block the opening of the coronary artery that supplies blood to the heart.
Such coronary artery occlusion can lead to fatal complications such as myocardial infarction, so a separate preventive step is needed before a redo. Previously, techniques such as "BASILICA," which involves incising the valve leaflets, or "UNICORN," which creates holes in the leaflets to secure a blood flow channel, were used.
LLAMACORN is a step forward from UNICORN. After making a small hole in the valve leaflet with a radiofrequency needle, a balloon is used to fully incise the leaflet tissue. By removing the existing leaflets, it lowers the chance of blocking the coronary arteries and allows for a wider choice of artificial valves.
In this case, the patient had a balloon-expandable TAVI valve implanted six years ago, but severe aortic stenosis recurred due to valve degeneration. In particular, because the left coronary height was low, inserting a new valve carried a high risk that the existing leaflets would be pushed and block the coronary artery.
Professor Jang's team determined that LLAMACORN, which can use a self-expanding valve, was more suitable than the conventional UNICORN technique and proceeded with the procedure. On the day after the procedure, echocardiography showed the peak aortic valve flow velocity (Vmax) decreased from 4.6 m/s to 2.1 m/s, returning to the normal range.
Jang Gi-yuk said, "For a considerable number of patients who need a TAVI redo, treatment options were limited because of the fatal risk of coronary artery occlusion," adding, "LLAMACORN secures a blood flow channel by artificially removing the valve leaflets and can offer a new treatment alternative for high-risk patients."
The Heart, Brain and Vascular Hospital at Seoul St. Mary's Hospital has been strengthening its capabilities in structural heart disease by setting a string of Korea's first records in interventional cardiology over the past five years.
Professor Jang's team increased its number of Korea's first procedures to five with LLAMACORN, following percutaneous inferior vena cava valve replacement (2021), axillary artery access TAVI (2022), BASILICA for coronary protection (2023), and transjugular aortic valve replacement (2026).