Author + information
- Johannes Schirmer1,
- David Michael Holzhey2,
- Jan-Malte Sinning3,
- Holger Schroefel4,
- Frank Oertel5,
- Sabine Bleiziffer6,
- Axel Unbehaun7,
- Alexander Lauten8,
- Christian Frerker9,
- Stefan Blankenberg1,
- Hermann Reichenspurner1,
- Lenard Conradi1 and
- Ulrich Schäfer1
- 1University Heart Center Hamburg, Hamburg, Germany
- 2Heart Center, Leipzig, Germany
- 3University of Bonn, Bonn, Germany
- 4Cardiac Surgery, University Heart Center Freiburg/Bad Krozingen, Germany, Bad Krozingen, Germany
- 5Augsburg Medical Center, Augsburg, Germany
- 6German Heart Center Munich, Munich, Germany
- 7German Heart Center Berlin, Berlin, Germany
- 8Charite - Universitatsmedizin Berlin, Berlin, Germany
- 9Asklepios Klinik St. Georg, Hamburg, Germany
Due to an increasing life expectancy, degenerative calcific mitral stenosis is becoming more prevalent in western developed countries. Severe mitral annular calcification is surgically challenging since decalcification may lead to irreparable damage. Thus, THV implantation in mitral position might be an alternative treatment concept.
A survey was conducted within Germany collecting cases of transcatheter mitral valve implantation for native calcific mitral stenosis using commercially available THV. Out of 72 centers, a total of 26 cases were reported from 12 centers. Data were collected in a dedicated database. A multicenter retrospective analysis of clinical outcomes was performed.
Mean age was 75.5+/-8.9 years (male 42.3 %; logEuroScore: 24.2+/-18.6 %; STS score: 9.4+/-6.3 %). In total, n=18 balloon-expandable valves and n=8 mechanical expanding valves were attempted for THV implantation. Access was transapical in 18 patients and transatrial in 3 patients. Furthermore, in 5 cases THV were implanted during open heart mitral valve surgery under visual guidance as a bail-out procedure. Acute procedural success was achieved in 21 patients (80 %). Significant left ventricular outflow tract (LVOT) obstruction occurred in 5 patients (19.2 %). Acute significant (> 2+) paravalvular leakage (PVL) was observed in 2 patients (7.6 %), whereas additional 3 patients (11.5 %) revealed delayed occurrence of significant PVL. Necessity of a second valve implantation (valve-in-valve) was present in 2 patients (7.6 %). Acute valve embolization/migration occurred in one patient (3.8 %), and delayed valve embolization/migration was observed in 2 patients (7.6 %). Despite low acute procedural mortality (3.8 %), overall in-hospital mortality was 23.1 %.
THV implantation for treatment of native calcific mitral stenosis might be a feasible concept in patients not suitable for conventional mitral valve replacement. However, high risk of LVOT obstruction and acute or delayed PVL requiring subsequent treatment represents a serious challenge. Thus, optimization of annulus sizing methods, optimal delivery strategies and patient selection seem to be crucial for procedural and sustained success.
STRUCTURAL: Valvular Disease: Mitral