Author + information
- Received November 15, 2012
- Revision received December 20, 2012
- Accepted January 8, 2013
- Published online April 30, 2013.
- Anson Cheung, MD⁎ (, )
- John G. Webb, MD,
- Marco Barbanti, MD,
- Melanie Freeman, MD,
- Ronald K. Binder, MD,
- Christopher Thompson, MD,
- David A. Wood, MD and
- Jian Ye, MD
- ↵⁎Reprint requests and correspondence:
Dr. Anson Cheung, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
Objectives The study sought to describe the authors' experience with mitral transapical transcatheter valve-in-valve implantation (TVIV).
Background Increasing numbers of mitral biological prostheses are being implanted in clinical practice. Transcatheter valve-in-valve implantation may be a lower risk alternative treatment for high-risk patients with mitral valve degeneration.
Methods Twenty-three consecutive patients with severe mitral bioprosthetic valve dysfunction underwent transapical mitral TVIV between July 2007 and September 2012. Bioprosthetic failure was secondary to stenosis in 6 (26.1%), regurgitation in 9 (39.1%), and combined in 8 (34.8%) patients.
Results All patients were elderly (mean age 81 ± 6 years) and at high-risk for conventional redo surgery (Society of Thoracic Surgeons score 12.1 ± 6.8%). Successful transapical mitral TVIV was accomplished in all patients using balloon expandable valves (Edwards Lifesciences, Irvine, California) 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 mm Hg to 6.9 ± 2.2 mm Hg following the procedure (p < 0.01). Intervalvular mitral regurgitation was absent (47.8%) or mild (52.2%) 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 (interquartile range: 376 to 1,119 days) survival was 90.4%. One patient underwent successful mitral TVIV reintervention at 2 months due to atrial migration of the transcatheter valve. All patients alive were in New York Heart Association functional class I/II with good prosthetic valve performance.
Conclusions Transcatheter transapical mitral valve-in-valve implantation for dysfunctional biological mitral prosthesis can be performed with minimal operative morbidity and mortality and favorable midterm clinical and hemodynamic outcomes.
Drs. Cheung, Webb, Binder, Thompson, Wood, and Ye are consultants to Edwards Lifesciences. Dr. Cheung has received consultant fees and is part of the Speakers' Bureau for Edwards Lifesciences. Dr. Webb is a consultant for Edwards Lifesciences. Dr. Wood is a consultant for Edwards Lifesciences and St. Jude Medical. Dr. Binder has received an unrestricted research grant from the Swiss National Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 15, 2012.
- Revision received December 20, 2012.
- Accepted January 8, 2013.
- American College of Cardiology Foundation