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5-Year Experience With Transcatheter Transapical Mitral Valve-in-Valve Implantation for Bioprosthetic Valve Dysfunction

2013; Elsevier BV; Volume: 61; Issue: 17 Linguagem: Inglês

10.1016/j.jacc.2013.01.058

1558-3597

Anson Cheung, John G. Webb, Marco Barbanti, Mélanie Freeman, Ronald K. Binder, Christopher Thompson, David A. Wood, Jian Ye,

Aortic Disease and Treatment Approaches

The study sought to describe the authors' experience with mitral transapical transcatheter valve-in-valve implantation (TVIV). Increasing numbers of mitral biological prostheses are being implanted in clinical practice. Transcatheter valve-in-valve implantation may be a lower risk alternative treatment for high-risk patients with mitral valve degeneration. Twenty-three consecutive patients with severe mitral bioprosthetic valve dysfunction underwent transapical mitral TVIV between July 2007 and September 2012. Bioprosthetic failure was secondary to stenosis in 6 (26.1%), regurgitation in 9 (39.1%), and combined in 8 (34.8%) patients. All patients were elderly (mean age 81 ± 6 years) and at high-risk for conventional redo surgery (Society of Thoracic Surgeons score 12.1 ± 6.8%). Successful transapical mitral TVIV was accomplished in all patients using balloon expandable valves (Edwards Lifesciences, Irvine, California) with no intraoperative major complications. One (4.4%) major stroke and 6 (26.1%) major bleeds were reported during hospitalization. Mitral transvalvular gradient significantly decreased from 11.1 ± 4.6 mm Hg to 6.9 ± 2.2 mm Hg following the procedure (p < 0.01). Intervalvular mitral regurgitation was absent (47.8%) or mild (52.2%) in all cases after mitral TVIV. No cases of transvalvular regurgitation were seen. All patients were alive on 30-day follow-up. At a median follow-up of 753 days (interquartile range: 376 to 1,119 days) survival was 90.4%. One patient underwent successful mitral TVIV reintervention at 2 months due to atrial migration of the transcatheter valve. All patients alive were in New York Heart Association functional class I/II with good prosthetic valve performance. Transcatheter transapical mitral valve-in-valve implantation for dysfunctional biological mitral prosthesis can be performed with minimal operative morbidity and mortality and favorable midterm clinical and hemodynamic outcomes.