Anterior mitral leaflet laceration using the MitraCut technique for transapical transcatheter Tendyne implantation after unsuccessful Carillon indirect annuloplasty: a case report

Abstract Background The introduction of a transapical transcatheter beating heart replacement system has significantly expanded therapeutic options for patients with severely diseased mitral valves, particularly those ineligibles for traditional surgery or transcatheter repair. However, challenges,...

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Published inEuropean heart journal : case reports Vol. 8; no. 2; p. ytae035
Main Authors de Manna, Nunzio Davide, Martens, Andreas, Jüttner, Marieke, Berliner, Dominik, Bauersachs, Johann, Ruhparwar, Arjang, Kempf, Tibor, Ius, Fabio
Format Journal Article
LanguageEnglish
Published US Oxford University Press 01.02.2024
Subjects
Associations, institutions, etc
Care and treatment
Grand Round
Health aspects
Heart failure
Implants, Artificial
Medical research
Medicine, Experimental
Methods
Prosthesis
Societies
Wounds and injuries
Germany
Transcatheter mitral valve implantation
Case report
Mitral valve regurgitation
Tendyne
Left ventricular outflow tract obstruction
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Summary:Abstract Background The introduction of a transapical transcatheter beating heart replacement system has significantly expanded therapeutic options for patients with severely diseased mitral valves, particularly those ineligibles for traditional surgery or transcatheter repair. However, challenges, such as left ventricular outflow tract obstruction (LVOT-O) and the risk of dynamic systolic anterior motion (SAM) in cases with elongated anterior mitral leaflet (AML) post-prosthesis implantation, impede the widespread adoption of transcatheter mitral valve replacement (TMVR). Case summary In 2022, a 75-year-old male with severe mixed-genesis mitral regurgitation (MR) underwent Carillon Mitral Contour System annuloplasty. Recurrent heart failure admissions (New York Heart Association IV) and prohibitive risk for open-heart surgery (European System for Cardiac Operative Risk Evaluation II 8.27%) prompted evaluation for Tendyne TMVR with the MitraCut technique. This beating heart transapical approach involved scissor-mediated splitting of the elongated 27 mm AML, essential for mitigating LVOT-O risk and dynamic SAM. The screening echocardiogram revealed the poorly tethered AML near the thickened septum at the simulated neo-LVOT site. Discussion This case underscores the intricate management challenges associated with severe MR, highlighting the successful application of the MitraCut technique as a viable alternative in high-risk scenarios. The imperative for further research and clinical studies is emphasized to comprehensively elucidate outcomes and safety parameters, providing valuable insights for refining TMVR applications within this context. Video Abstract 10.1093/ehjcr/ytae035_video1 Video Abstract ytae035media1 6345938870112
Bibliography:Conflict of interest: None declared.
ISSN:2514-2119
2514-2119
DOI:10.1093/ehjcr/ytae035