Transcatheter Mitral Valve Replacement in Patients With Previous Aortic Valve Replacement.

Abstract

BACKGROUND:

Transcatheter mitral valve replacement (TMVR) may mature to become a therapeutic option for high-risk patients with severe mitral regurgitation (MR), particularly in patients at high or prohibitive surgical risk. MR patients with preexisting aortic valve prosthesis have been excluded from most TMVR trials because of the potential risks of left ventricular outflow tract obstruction or interaction between the TMVR anchoring mechanism and the aortic prosthesis. We describe the procedural and short-term outcomes of transapical TMVR with the Tiara valve in patients experiencing severe symptomatic MR with previous aortic valve replacement (AVR).

METHODS AND RESULTS:

Twelve consecutive high surgical risk patients (11 men; mean age, 75±6 years) with aortic valve prosthesis and severe MR underwent TMVR with Tiara valve. Aortic valves were mechanical in 5 and biological in 7 patients, while 1 patient had previously undergone implantation of a transcatheter valve within a failed bioprosthetic surgical valve. Six patients (50%) had undergone redo surgical aortic valve replacement. Clinical characteristics of the group include prior mitral valve repair in 2, prior coronary bypass grafting surgery in 5, chronic atrial fibrillation in 7, renal failure in 9, and pacemaker/cardiac resynchronization device in 9 patients. Mean Society of Thoracic Surgery score and EuroSCORE II were 10.5±4.4 and 12.4±3.7, respectively. Mean baseline left ventricular ejection fraction was 35.5±5.3% (range, 30%-45%). The Tiara valve was implanted uneventfully in all patients. Device migration or left ventricular outflow tract obstruction was not observed. No patient required conversion to open heart surgery or periprocedural hemodynamic support. Procedural success was 100% with no death, MI, stroke, major bleeding, or access site complications at 30 days. MR was eliminated in all 12 patients immediately after implantation.

CONCLUSIONS:

Transapical mitral valve replacement with the Tiara valve in high-risk patients with severe MR and aortic valve prostheses is technically feasible and can be performed safely.

• Authors: Anson Cheung, John Webb, Ulrich Schaefer, Robert Moss, Florian G Deuschl, Lenard Conradi, Paolo Denti, Azeem Latib, Bob Kiaii, Rodrigo Bagur, Enrico Ferrari, Marco Moccetti, Luigi Biasco, Philippe Blanke, Yanai Ben-Gal, Shmuel Banai
• Journal: Circulation. Cardiovascular interventions (Circ Cardiovasc Interv) Vol. 11 Issue 10 Pg. e006412 (10 2018) ISSN: 1941-7632 [Electronic] United States
• PMID: 30354628 (Publication Type: Journal Article)

Topics

• Aged
• Aged, 80 and over
• Aortic Valve (diagnostic imaging, physiopathology, surgery)
• Bioprosthesis
• Cardiac Catheterization (adverse effects, instrumentation, methods)
• Echocardiography, Three-Dimensional
• Female
• Heart Valve Prosthesis
• Heart Valve Prosthesis Implantation (adverse effects, instrumentation, methods)
• Hemodynamics
• Humans
• Male
• Mitral Valve (diagnostic imaging, physiopathology, surgery)
• Mitral Valve Insufficiency (diagnostic imaging, physiopathology, surgery)
• Postoperative Complications (etiology)
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Tomography, X-Ray Computed
• Treatment Outcome