Author + information
- Claire Bouleti,
- Dominique Himbert,
- Bernard Iung,
- Marina Urena,
- Amir-Ali Fassa,
- Eric Brochet,
- Phalla Ou,
- Patrick Nataf and
- Alec Vahanian
Redo mitral surgery may be high risk or contraindicated. We evaluated mid-term results of transfemoral transcatheter mitral valve implantation (TMVI) in failed bioprostheses (BP) and ring annuloplasties (RA).
Transfemoral implantation of Edwards Sapien XT prosthesis was performed in 31 patients for degenerated mitral BP (n=13) or RA (n=18) between 2011 and 2015. Mean age was 61±24 years, all patients were in NYHA≥III, with a high surgical risk (EuroSCORE 38±26%). The cause of failure was regurgitation in 14 patients, stenosis in 14 and both in 3.
Procedure was unsuccessful in 5 patients: 1 procedural death and 1 THV migration on patients with ECMO, 1 conversion to surgery, 1 need for a second prosthesis and 1 moderate paraprosthetic regurgitation. In the 17 patients with stenosis, mean gradient decreased from 14±5mmHg to 8±3mmHg (p<0.0001), whereas all but 1 patient had mitral regurgitation ≤2/4 after the procedure. During hospitalization, 3 patients died (1 rupture of inferior vena cava, 1 infective endocarditis and 1 urgent surgery for aorta perforation). Among the 28 patients discharged alive, the 18-months survival rate was 77±11% (Figure), with 6 patients who died during follow-up, mostly from cardiac cause (3 sudden death, 2 heart failure). At last FU among survivors, 21 patients were in NYHA I-II, and only 1 in NYHA III.
Transfemoral TMVI for deterioration of BP or surgical repair may be performed in high-risk patients and provides good mid-term results.
Poster Area, South Hall A1
Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m.
Session Title: Important Clinical Considerations in Managing Patients With Valvular Heart Disease
Abstract Category: 41. Valvular Heart Disease: Therapy
Presentation Number: 1216-045
- 2016 American College of Cardiology Foundation