Author + information
- Lena Katharina Eschenbach1,
- Marcus-André Deutsch2,
- Magdalena Erlebach2,
- Hendrik Ruge2,
- Ruediger Lange2 and
- Sabine Bleiziffer2
Transcatheter valve-in-valve implantation (mViV) in patients with failing mitral bioprostheses is an emerging alternative for high-risk patients. We evaluated the mean pressure gradient (pmean) after mViV and if stenosis or insufficiency of the bioprosthetic has a differential impact on survival.
From 06/10-06/17 25 patients received mViV for degeneration of the bioprosthetic mitral valve.
Mean patient age was 68.2±14.7 years. Mean logistic EuroScore was 19.7%±11.7. Twelve (48%) patients were female. The median duration from mitral valve replacement until mViV was 10±3.5years. Fourteen (56%) patients showed a stenosis (MS) of their bioprosthesis (pmean preoperatively 14.1±4.2mmHg), six (24%) an insufficiency (MI) and the remaining five (20%) a combined valve pathology (MC). The majority of the procedures was performed through a transapical access (n=20), one patient received a transatrial access. Since 11/16, we have started to perform all procedures transseptally (n=4). Twenty-four Edwards Sapien valves (Edwards Lifesciences) and one Direct Flow prosthesis (Direct Flow Medical Inc.) were implanted. Periprocedural complications included n=1 conversion to surgical mitral valve replacement for valve migration, n=1 major bleeding from transapical access site, n=1 transient ischemic attack and n=1 valve thrombosis. In three patients a mild valvular and in three patients a mild paravalvular regurgitation was seen postoperatively. After mViV the mean pressure gradient of patients with MS declined to 7.1±4.1mmHg (p=0.001) and in patients with MI or MC to 5.7±2.3mmHg (p=0.04), respectively. 30-day survival was 100% for transseptal and non-transseptal access. One-year-survival was similar regardless of the mode of bioprosthetic valve failure with 91.7% for MS, 83.3% for MI and 100% for MC (p=n.s.), respectively.
MViV can be deemed a reasonable therapeutic option for patients with degenerated mitral bioprostheses showing a low complication rate and reasonable survival in high risk patients. Hemodynamic assessment revealed significantly improved pressure gradients and only mild residual regurgitation.
STRUCTURAL: Valvular Disease: Mitral