Transcatheter mitral valve implantation via transapical approach: an early experience.

Abstract

OBJECTIVES:

As many as 50% of patients with severe symptomatic mitral valve regurgitation are denied surgical valve replacement or repair due to high operative risk. We describe an early series of cases of transcatheter implantation with a CardiAQ™ mitral valve via a transapical approach.

METHODS:

Three consecutive patients with an Society of Thoracic Surgeons (STS) mortality score of >22% were selected for transcatheter mitral valve implantation (TMVI) on compassionate grounds. All patients were elderly, had severe mitral regurgitation (MR), were in Class IV heart failure and deemed unsuitable for the MitraClip. Two of the patients had functional MR in the setting of ischaemic cardiomyopathy with left ventricular ejection fraction (LVEF) <40%, deemed while the remaining patient had chordal rupture with extensive anterior leaflet flail (preserved LVEF). Comorbidities included previous coronary artery bypass surgery (n = 2), severe pulmonary hypertension (n = 1) and moderate to severe chronic renal failure (n = 3). A CardiAQ mitral valve was implanted using fluoroscopy and transoesophageal (TEE) guidance via a standard transapical approach.

RESULTS:

Accurate prosthesis positioning and deployment with immediate elimination of the MR was achieved in all 3 cases. Two patients made full clinical recovery and were discharged home. Post-procedural TEE performed on Days 1, 30 and 60 days showed good valve function, stable valve position and minimal LVOT gradient. One patient expired on the postoperative day 9 due to pneumonia.

CONCLUSIONS:

TMVI using the CardiAQ™ device via a transapical approach is feasible and effective.

• Authors: Lars Sondergaard, Matthew Brooks, Nikolaj Ihlemann, Anders Jonsson, Susanne Holme, Mariann Tang, Kim Terp, Arshad Quadri
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 48 Issue 6 Pg. 873-7; discussion 877-8 (Dec 2015) ISSN: 1873-734X [Electronic] Germany
• PMID: 25653251 (Publication Type: Journal Article)
• Copyright: © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Female
• Heart Valve Prosthesis
• Heart Valve Prosthesis Implantation (methods)
• Humans
• Male
• Mitral Valve (surgery)
• Mitral Valve Insufficiency (surgery)
• Treatment Outcome