Dataset Information

"Gazing Into the Abyss": Transcatheter Mitral Valve-in-Valve Implantation Through a Cavernous Left Atrium.

ABSTRACT: We describe the case of a 73-year-old woman presenting with heart failure, a degenerating bioprosthetic mitral valve, and severely dilated left atrium, and highlight the role of multimodality imaging in planning transseptal transcatheter mitral valve-in-valve implantation. (Level of Difficulty: Advanced.).

SUBMITTER: Aroney NP

PROVIDER: S-EPMC8387806 | biostudies-literature | 2021 Aug

REPOSITORIES: biostudies-literature

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"Gazing Into the Abyss": Transcatheter Mitral Valve-in-Valve Implantation Through a Cavernous Left Atrium.

Aroney Nicholas P NP Rajani Ronak R Patterson Tiffany T Allen Christopher J CJ Gill Harminder H Grapsa Julia J Hancock Jane J Prendergast Bernard B Redwood Simon S

JACC. Case reports 20210630 10

We describe the case of a 73-year-old woman presenting with heart failure, a degenerating bioprosthetic mitral valve, and severely dilated left atrium, and highlight the role of multimodality imaging in planning transseptal transcatheter mitral valve-in-valve implantation. (<b>Level of Difficulty: Advanced.</b>). ...[more]

PMID: 34471889

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Project description:BackgroundTranscatheter methods have been rapidly evolving to provide an alternative less invasive therapeutic option, mainly because redo patients often present with multiple comorbidities and high operative risk. We sought to evaluate and compare our experience with transapical transcatheter mitral valve replacement (TA-TMVR) to conventional redo mitral valve replacement in patients presenting with degenerated biological mitral valve prostheses or failed valve annuloplasty.Methods and materialBetween March 2012 and November 2020, 74 consecutive high-risk patients underwent surgical redo mitral valve replacement (n = 33) or TA-TMVR (n = 41) at our institution. All patients presented with a history of a surgical mitral valve procedure. All transcatheter procedures were performed using the SAPIEN XT/3™ prostheses. Data collection was prospectively according to MVARC criteria.ResultsThe mean logistic EuroSCORE-II of the whole cohort was 19.9±16.7%, and the median STS-score was 11.1±12.5%. The mean age in the SMVR group was 63.7±12.8 years and in the TMVR group 73.6±9.7 years. Patients undergoing TA-TMVR presented with significantly higher risk scores. Echocardiography at follow up showed no obstruction of the left ventricular outflow tract, no paravalvular leakage and excellent transvalvular gradients in both groups (3.9±1.2 mmHg and 4.2±0.8 mmHg in the surgical and transcatheter arm respectively). There was no difference in postoperative major adverse events between the groups with no strokes in the whole cohort. Both methods showed similar survival rates at one year and a 30-day mortality of 15.2% and 9.8% in SAVR and TMVR group, respectively. Despite using contrast dye in the transcatheter group, the rate of postoperative acute kidney failure was similar between the groups.ConclusionDespite several contraindications for surgery, we showed the non-inferiority of TA-TMVR compared to conventional surgical redo procedures in high-risk patients. With its excellent hemodynamic and similar survival rate, TA-TMVR offers a feasible alternative to the conventional surgical redo procedure in selected patients.

Dataset Information

"Gazing Into the Abyss": Transcatheter Mitral Valve-in-Valve Implantation Through a Cavernous Left Atrium.

Publications

"Gazing Into the Abyss": Transcatheter Mitral Valve-in-Valve Implantation Through a Cavernous Left Atrium.

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