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Transapical transcatheter mitral valve-in-valve implantation (TA-MVIVR) for degraded bioprostheses is an alternative to re-operation in high risk patients. We report our outcomes in a patient population with a high proportion of cardiogenic shock.
Retrospective review was performed of all patients undergoing TA-MVIVR with an Edwards Sapien (Edwards Life-sciences, Irvine, CA) prosthesis at our center between the years 2013-2017.
A total of 19 patients with degraded bioprosthetic mitral valves were included (mean age 78 +/- 12 years). All patients were New York Heart Association (NYHA) class ≥ III; median Society of Thoracic Surgeons Score was 14.2 (IQR 8.4-29). TA-MVIVR was performed in the setting of cardiogenic shock in 12/19 patients (63%). The primary mechanism for valve failure was regurgitation in 58%, stenosis in 21%, and mixed in 21%. All patients underwent successful TA-TMVI implantation with no mortalities, strokes, or myocardial infarctions at 30 days. Mean transmitral gradient decreased from 12 +/- 5mmHg to 5 +/- 3 mmHg (p = 0.0005) (Image). Two patients had post-procedural cardiac arrest but had full recovery. There was one mortality from unknown causes within the first year (5.2%). At a mean follow up of 339 days (range 30 – 1291), 3/19 patients (15.8%) had developed trace transvalvular regurgitation. There was no paravalvular regurgitation. At last follow up, 89% of patients were NYHA class I or II.
TA-MVIVR for degenerated bioprostheses can safely be performed in a patient population with a high proportion of cardiogenic shock with favorable clinical outcomes.
STRUCTURAL: Valvular Disease: Mitral