Author + information
- Chad Kliger,
- Rocio Angulo,
- Leandro Maranan,
- Robert Kumar,
- Vladimir Jelnin,
- Itzhak Kronzon,
- Gila Perk and
- Carlos Ruiz
Structural deterioration and paravalvular leak (PVL) are complications associated with surgically–implanted prosthetic valves. Until recently, the only available treatment has been surgery. Percutaneous PVL closure has demonstrated reasonable technical success and clinical outcomes. In addition, transcatheter valve–in–valve (ViV) implantation for failing bioprostheses is currently being utilized as an alternative to surgical valve replacement in high–risk or inoperable patients.
From March 2012 to October 2012, we reviewed consecutive patients (n=5, mean age 73) who underwent transcatheter repair of a failed mitral bioprosthesis with severe paravalvular regurgitation (PVR) at our institution. All patients were deemed high–risk for surgery with average STS and euroSCORE of 15.1%±12 and 25.9%±15. Manufacturer valve sizes ranged from 27 to 33mm with mode of failure being regurgitation (n=1), stenosis (n=1), and both (n=3). Transapical and transseptal access was achieved with PVL closure performed transapically using Amplatzer devices (St Jude Medical, MN). An arteriovenous rail was created for transseptal delivery of the Melody valve (off–label, Medtronic MN) on a 24mm BiB balloon (NuMED, NY).
All patients had successful PVL closure with no evidence of residual PVR. Melody ViV implantation was successful in 4 of 5 patients. Overall, mean transvalvular mitral gradient was 11.2mmHg pre–procedure that improved to 5mmHg post–procedure. An improvement of NYHA class >2 was achieved in all patients at 5±3 months follow–up. One patient had controlled Melody valve embolization during the procedure that required emergent surgical removal and replacement. Review of imaging revealed an inner valve diameter of 26mm, too large for Melody valve implantation.
Complete transcatheter repair of a degenerative mitral bioprosthesis with PVR can be performed in the high–risk patient. Accurate measurement of the surgical prosthesis is necessary prior to intervention, with concern for embolization among the larger sizes (> 31mm). Further study is required to evaluate the safety and long–term durability of Melody ViV implantation in the mitral position.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Structural Heart Disease Intervention
Abstract Category: 50. TCT@ACC–i2: Mitral Valve Disease
Presentation Number: 2114–249
- 2013 American College of Cardiology Foundation