Author + information
- Marco Barbanti,
- John Webb,
- Freeman Melanie,
- Ronald Binder,
- Christopher Thompson,
- David Wood and
- Anson Cheung
Increasing numbers of mitral biological prostheses are being implanted in clinical practice. As these valves eventually fail the requirement for mitral valve re–replacement will continue to rise. However, the morbidity and mortality of reoperation is higher than the index procedure. Transcatheter valve–in–valve implantation may be a lower risk alternative in high–risk patients. We describe our experience with mitral transapical transcatheter valve–in–valve implantation (TVIV).
Twenty–three consecutive patients with severe mitral bioprosthetic valve dysfunction underwent transapical mitral TVIV between July 2007 and September 2012. Patient data were prospectively collected and entered into a dedicated database. Bioprosthetic failure was secondary to stenosis in 6 (26.1%), regurgitation in 9 (39.1%), and combined in 8 (34.8%) patients.
All patients were elderly (mean age 81±6 years) and at high–risk for conventional re–do surgery (mean STS risk score 12.1±6.8%). Successful transapical mitral TVIV was accomplished in all patients using balloon–expandable valves (Edwards Lifesciences, Irvine CA) with no intraoperative major complications. One (4.4%) major stroke and 6 (26.1%) major bleeds were reported during hospitalization. Mitral transvalvular gradient significantly decreased from 11.1±4.6 mmHg to 6.9±2.2 mmHg following the procedure. Intervalvular mitral regurgitation was absent or mild in all cases after mitral TVIV. No cases of transvalvular regurgitation were seen. All patients were alive on 30–day follow up. At a median follow–up of 753 days (IQR 376–1119) survival was 86.9%. One patient underwent successful mitral TVIV re–intervention due to atrial migration of the transcatheter valve. All patients alive were in NYHA functional class I/II with good prosthetic valve performance.
Transcatheter transapical mitral valve–in–valve implantation for dysfunctional biological mitral prosthesis can be performed with minimal operative morbidity and mortality and excellent mid–term clinical and hemodynamic outcomes.
West, Room 2022
Sunday, March 10, 2013, 8:15 a.m.–8:25 a.m.
Session Title: Structural Heart Disease (Non–TAVR)
Abstract Category: 50. TCT@ACC–i2: Mitral ValveDisease
Presentation Number: 2906–3
- 2013 American College of Cardiology Foundation