Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification

• Published in: JACC. Cardiovascular interventions Vol. 9; no. 11; pp. 1161 - 1174
• Main Authors: Eleid, Mackram F., MD, Cabalka, Allison K., MD, Williams, Matthew R., MD, Whisenant, Brian K., MD, Alli, Oluseun O., MD, Fam, Neil, MD, Pollak, Peter M., MD, Barrow, Firas, MD, Malouf, Joseph F., MD, Nishimura, Rick A., MD, Joyce, Lyle D., MD, PhD, Dearani, Joseph A., MD, Rihal, Charanjit S., MD, MBA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 13.06.2016
• Subjects: Aged; Aged, 80 and over; Bioprosthesis; Calcinosis - diagnostic imaging; Calcinosis - physiopathology; Calcinosis - surgery; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Cardiovascular; Disease-Free Survival; Echocardiography, Doppler, Color; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Feasibility Studies; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - methods; Hemodynamics; Humans; Male; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Annuloplasty - adverse effects; Mitral Valve Annuloplasty - instrumentation; Mitral Valve Annuloplasty - methods; mitral valve implantation; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Ontario; percutaneous; Prosthesis Design; Prosthesis Failure; Radiography, Interventional; Recovery of Function; Risk Factors; Time Factors; transcatheter valve; transseptal; Treatment Outcome; United States; computed tomography; ECMO; NYHA; percutaneous; LV; left ventricular/ventricle; MAC; mitral annular calcification; mitral valve implantation; CT; New York Heart Association; TEE; extracorporeal membrane oxygenation; transesophageal echocardiography; transseptal; transcatheter valve
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2016.02.041

Abstract Objectives The study sought to examine the feasibility, safety, and intermediate-term outcomes in patients undergoing percutaneous transvenous transcatheter mitral valve implantation in failed bioprosthesis, ring annuloplasty, and calcific mitral stenosis. Background Surgical mitral valve replacement in patients with previous surgery or severe mitral annular calcification (MAC) is often associated with high or prohibitive risk. Methods Percutaneous transfemoral antegrade transseptal implantation of Edwards SAPIEN prosthesis (Edwards Lifesciences, Irvine, California) was performed in 48 patients with degenerated mitral bioprosthesis (n = 33), previous ring annuloplasty (n = 9), and severe MAC (n = 6). Results The mean Society of Thoracic Surgeons risk score was 13.2 ± 7.4% with a mean age 76 ± 11 years. Acute procedural success was achieved in 42 of 48 patients (88%) in the overall group and 31 of 33 (94%) in the failed bioprosthetic mitral valve group and success rate of 11 of 15 (73%) in patients with failed annuloplasty rings and MAC. After successful procedure, no patients had > mild residual mitral prosthetic or periprosthetic regurgitation; mean transvalvular gradients were 6 ± 2.5 mm Hg. Thirty-day survival free of death and cardiovascular surgery was 85% in the overall group and 91% in the failed bioprosthetic mitral valve subgroup. Conclusions Transfemoral percutaneous transvenous mitral valve implantation in high-risk patients with degenerated bioprosthesis is safe, effective, and associated with rapid improvement in hemodynamics, short length of stays, and improved functional status. Percutaneous mitral valve implantation in patients with failed annuloplasty rings and severe MAC is a promising therapy with significant short-term morbidity and mortality that requires further study.