Transcatheter Mitral Valve-in-Valve Implantation in Patients With Degenerated Bioprostheses

• Published in: JACC. Cardiovascular interventions Vol. 5; no. 3; pp. 341 - 349
• Main Authors: Seiffert, Moritz, Conradi, Lenard, Baldus, Stephan, Schirmer, Johannes, Knap, Malgorzata, Blankenberg, Stefan, Reichenspurner, Hermann, Treede, Hendrik
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2012
• Subjects: Aged; Aged, 80 and over; Bioprosthesis; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Cardiac Catheterization - mortality; Cardiovascular; Catheterization; Female; Germany; Heart Valve Diseases - surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Humans; Logistic Models; Middle Aged; mitral regurgitation; mitral stenosis; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Prosthesis Design; Prosthesis Failure; Radiography; reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; transapical; Treatment Outcome; Ultrasonography; valve surgery; NYHA; THV; mitral regurgitation; MR; mitral stenosis; EOA; TAVI; reoperation; MVR; IQR; transapical; valve surgery; transcatheter aortic valve implantation; transcatheter heart valve; interquartile range; effective orifice area; New York Heart Association; mitral valve replacement
• ISSN: 1936-8798; 1876-7605; 1876-7605
• DOI: 10.1016/j.jcin.2011.12.008

This study reports the results of a series of transapical mitral valve-in-valve implantations and aims to offer guidance on technical aspects of the procedure. Mitral valve reoperations due to failing bioprostheses are associated with high morbidity and mortality. Transcatheter techniques may evolve as complementary approaches to surgery in these high-risk patients. Six patients (age 75 ± 15 years) received transapical implantation of a balloon-expandable pericardial heart valve into a degenerated bioprosthesis (range 27 to 31 mm) in mitral position at our institution. All patients were considered high risk for surgical valve replacement (logistic EuroSCORE: 33 ± 15%) after evaluation by an interdisciplinary heart team. Procedural and clinical outcomes were analyzed. Implantation was successful in all patients with reduction of mean transvalvular gradients from 11.3 ± 5.2 mm Hg to 5.5 ± 3.6 mm Hg (p = 0.016) and median regurgitation from grade 3.0 (interquartile range [IQR]: 2.7 to 3.1) to 0 (IQR: 0 to 1.0, p = 0.033) with trace paravalvular regurgitation remaining in 2 patients. Apical bleeding occurred in 2 patients requiring rethoracotomy in 1 and resuscitation in a second patient, the latter of whom died on postoperative day 6. In the remaining patients, median New York Heart Association functional class improved from 3.0 (IQR: 3.0 to 3.5) to 2.0 (IQR: 1.5 to 2.0, p = 0.048) over a median follow-up of 70 (IQR: 25.5 to 358) days. With acceptable results in a high-risk population, transapical mitral valve-in-valve implantation can be considered as a complementary approach to reoperative mitral valve surgery in select patients.