First Reported Case of Transcatheter Mitral Valve Implantation in Mitral Annular Calcification With a Fully Repositionable and Self-Expanding Valve
2015; Lippincott Williams & Wilkins; Volume: 8; Issue: 11 Linguagem: Inglês
10.1161/circinterventions.115.003031
ISSN1941-7632
AutoresZhan Yun Lim, Ricardo Boix, Bernard Prendergast, Ronak Rajani, Simon Redwood, Jane Hancock, Christopher Young, Vinayak Bapat,
Tópico(s)Cardiac Structural Anomalies and Repair
ResumoHomeCirculation: Cardiovascular InterventionsVol. 8, No. 11First Reported Case of Transcatheter Mitral Valve Implantation in Mitral Annular Calcification With a Fully Repositionable and Self-Expanding Valve Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBFirst Reported Case of Transcatheter Mitral Valve Implantation in Mitral Annular Calcification With a Fully Repositionable and Self-Expanding Valve Zhan Yun Lim, MBBS, Ricardo Boix, MD, Bernard Prendergast, MD, Ronak Rajani, MD, BM, Simon Redwood, MD, Jane Hancock, MBChB, PhD, Christopher Young, MD and Vinayak (Vinnie) Bapat, FRCS(CTh) Zhan Yun LimZhan Yun Lim From the Department of Cardiology and Cardiac Surgery, St Thomas' Hospital, London, United Kingdom. , Ricardo BoixRicardo Boix From the Department of Cardiology and Cardiac Surgery, St Thomas' Hospital, London, United Kingdom. , Bernard PrendergastBernard Prendergast From the Department of Cardiology and Cardiac Surgery, St Thomas' Hospital, London, United Kingdom. , Ronak RajaniRonak Rajani From the Department of Cardiology and Cardiac Surgery, St Thomas' Hospital, London, United Kingdom. , Simon RedwoodSimon Redwood From the Department of Cardiology and Cardiac Surgery, St Thomas' Hospital, London, United Kingdom. , Jane HancockJane Hancock From the Department of Cardiology and Cardiac Surgery, St Thomas' Hospital, London, United Kingdom. , Christopher YoungChristopher Young From the Department of Cardiology and Cardiac Surgery, St Thomas' Hospital, London, United Kingdom. and Vinayak (Vinnie) BapatVinayak (Vinnie) Bapat From the Department of Cardiology and Cardiac Surgery, St Thomas' Hospital, London, United Kingdom. Originally published9 Nov 2015https://doi.org/10.1161/CIRCINTERVENTIONS.115.003031Circulation: Cardiovascular Interventions. 2015;8:e003031Mitral valve intervention in heavy mitral annular calcification (MAC) presents significant surgical challenges. Current dedicated transcatheter mitral valve therapy excludes patients with significant MAC. Transcatheter aortic valve implantation devices have been used for mitral valve-in-valve and valve-in-ring procedures.1 Balloon-expandable valves have been used with some success in the presence of MAC, but their use is limited by the inability to reposition if left ventricular outflow tract (LVOT) obstruction occurs.2 We describe 2 cases, where a self-expanding and repositionable transcatheter valve was implanted in the mitral position using MAC as an anchor.Case 1A 75-year-old woman presented with increasing breathlessness after her aortic valve replacement and mitral valve repair in 2014. Echocardiography demonstrated a functioning prosthetic aortic valve and severe mitral regurgitation. The mitral annulus had a measured perimeter of 77 mm and area of 400 mm2 (transesophageal echocardiography) with an aortomitral annular angle of 124° (computed tomography).Case 2A 62-year-old man presented with New York Heart Association III symptoms. Medical history included Alport syndrome, transcatheter aortic valve implantation (26 mm Sapien XT), and permanent pacemaker. Echocardiography demonstrated a functioning prosthetic aortic valve and severe mitral regurgitation. The mitral annulus had a measured perimeter of 82 mm and area of 440 mm2 (transesophageal echocardiography) with an aortomitral annular angle of 140° (computed tomography).ProcedureIn both cases, preprocedural multimodality imaging was crucial to assessment of feasibility (Figures 1 and 2). The procedure was performed via transapical access. The mitral valve was crossed with a multipurpose catheter and exchanged for a SAFARI wire. The procedure was guided by fluoroscopy (initial device placement) and transesophageal echocardiography (assessment of valve function and LVOT obstruction). In the first case, the valve was resheathed after 60% deployment to optimize final position.Download figureDownload PowerPointFigure 1. Transesophageal echocardiogram (case 1). Multiplanar reformatted images demonstrating the measurement of mitral valve annulus size by evaluating the annulus in 2 orthogonal planes (A and B). From this approach, the mitral valve annulus perimeter and area may be measured (C). The arrow shows the sites of mitral valve annulus calcification. LA indicates left atrium.Download figureDownload PowerPointFigure 2. Multidetector computed tomography (case 2). Multiplanar reformatted images were used to visualize the distribution of mitral valve annulus calcification (A). There is circumferential calcification indicating adequate anchoring properties of the annulus for a transcatheter valve. B and C, The apical long axis and 2-chamber views, the mitral valve calcification, and the relationship with the left ventricular outflow tract. D, Measurements taken to interrogate the annulus and left ventricular outflow tract and the likelihood of postprocedural outflow tract obstruction. The aortomitral annular angle was measured as the angle between the left ventricular outflow tract (LVOT) and the base of the A2 and P2 scallops in the 3-chamber view. Measurements of the annulus and LVOT were also taken in this view. Perpendicular lines measuring 20 mm were then drawn at the bases of the A2 and P2 scallops to project into the left ventricle (LV) to simulate the position of the transcatheter valve and the impact on the LVOT. Twenty millimeter was selected as a means to introduce a margin of safety to account for variable deployment positions. The arrows show the sites of mitral valve annulus calcification. Ao indicates ascending aorta; LA, left atrium; and RV, right ventricle.In both cases, the LOTUS valve system was deployed with a good waist, excellent hemodynamic performance, and no LVOT obstruction (Figures 3–5). The mean transvalvular gradients were 4 and 7 mm Hg, respectively, with no more than mild paravalvular regurgitation. After a period of recovery with no postprocedural complications, both patients were discharged home on day 6 on warfarin.Download figureDownload PowerPointFigure 3. Fluoroscopy images (case 2). A, The transapical approach with the SAFARI wire across the mitral valve within the left atrium and the deployment of a 22F Cook Sheath. B, The unsheathing of the Lotus valve within the mitral annulus. C, The evaluation of the Lotus valve unsheathed before deployment. D, Lotus valve deployed with the nose cone and SAFARI wire retrieved within the sheath. The white line shows the mitral valve annulus calcification. TAVI indicates transcatheter aortic valve implantation; and TMVR, transcatheter mitral valve replacement.Download figureDownload PowerPointFigure 4. Postprocedural fluoroscopy images. A and B, Different fluoroscopic projections of the Lotus valve and Perimount valve in situ (case 1). AVR indicates aortic valve replacement; and TMVR, transcatheter mitral valve replacement.Download figureDownload PowerPointFigure 5. Three-dimensional transesophageal echocardiogram (case 1). The left atrial surgical view of the Lotus valve in situ in both the closed (A) and open (B) positions. Corresponding coronal views of the Lotus valve in the closed (C) and open (D) positions. The white line shows the Lotus valve ring in situ. LA indicates left atrium; and LV, left ventricle.DiscussionThe treatment of degenerative native mitral valve disease is feasible with balloon-expandable transcatheter aortic valve implantation devices. However, this has been associated with LVOT obstruction, embolization/migration,3 and annular damage.4 These potential disadvantages may be overcome by the use of a self-expandable and repositionable device. LVOT obstruction and security of fixation can be assessed once optimal positioning has been achieved. Gradual implantation can also minimize the risk of annular damage (despite deliberate oversizing).The accuracy of mitral annular sizing and assessment of the potential risk of LVOT obstruction will only improve with more experience. Meanwhile, these initial cases indicate the feasibility and effectiveness of transcatheter mitral valve implantation in MAC using a fully repositionable and self-expanding valve. Similar success has also been reported with the Direct Flow Medical aortic.5 Subject to careful preprocedural anatomic assessment (annular sizing, aortomitral annular, and LV cavity dimensions), this novel approach may prove an effective treatment option for highly selected patients who would otherwise be declined intervention.Sources of FundingV. N. Bapat received research grant from Edwards Lifesciences.DisclosuresV. N. Bapat has served as a consultant to Boston Scientific, Sorin, and Edwards Lifesciences. The other authors report no conflicts.FootnotesMovies I–III are available in the Data Supplement.The Data Supplement is available at http://circinterventions.ahajournals.org/lookup/suppl/doi:10.1161/CIRCINTERVENTIONS.115.003031/-/DC1.Correspondence to Vinayak (Vinnie) Bapat, FRCS(CTh), Department of Cardiology and Cardiac Surgery, St Thomas' Hospital, 6th Floor E Wing, Westminster Bridge Rd, London SE1 7EH, United Kingdom. E-mail [email protected]References1. Bouleti C, Fassa AA, Himbert D, Brochet E, Ducrocq G, Nejjari M, Ghodbane W, Depoix JP, Nataf P, Vahanian A. Transfemoral implantation of transcatheter heart valves after deterioration of mitral bioprosthesis or previous ring annuloplasty.JACC Cardiovasc Interv. 2015; 8(1 pt A):83–91. doi: 10.1016/j.jcin.2014.07.026.Google Scholar2. Himbert D, Bouleti C, Iung B, Nejjari M, Brochet E, Depoix JP, Ghodbane W, Fassa AA, Nataf P, Vahanian A. Transcatheter valve replacement in patients with severe mitral valve disease and annular calcification.J Am Coll Cardiol. 2014; 64:2557–2558. doi: 10.1016/j.jacc.2014.09.047.CrossrefMedlineGoogle Scholar3. Bapat VV, Khaliel F, Ihleberg L. Delayed migration of Sapien valve following a transcatheter mitral valve-in-valve implantation.Catheter Cardiovasc Interv. 2014; 83:E150–E154. doi: 10.1002/ccd.25076.CrossrefMedlineGoogle Scholar4. Pasic M, Unbehaun A, Dreysse S, Buz S, Drews T, Kukucka M, D'Ancona G, Seifert B, Hetzer R. Rupture of the device landing zone during transcatheter aortic valve implantation: a life-threatening but treatable complication.Circ Cardiovasc Interv. 2012; 5:424–432. doi: 10.1161/CIRCINTERVENTIONS.111.967315.LinkGoogle Scholar5. Mellert F, Sinning JM, Werner N, Welz A, Grube E, Nickenig G, Hammerstingl C. First-in-man transapical mitral valve replacement using the Direct Flow Medical® aortic valve prosthesis.Eur Heart J. 2015; 36:2119. doi: 10.1093/eurheartj/ehv167.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Sazzad F, Hon J, Ramanathan K, Nah J, Ong Z, Ti L, Foo R, Tay E and Kofidis T (2022) Design Variation, Implantation, and Outcome of Transcatheter Mitral Valve Prosthesis: A Comprehensive Review, Frontiers in Cardiovascular Medicine, 10.3389/fcvm.2021.782278, 8 Bagaev E, Ali A, Saha S, Sadoni S, Orban M, Naebauer M, Mehilli J, Massberg S, Oberbach A and Hagl C (2022) Hybrid Surgery for Severe Mitral Valve Calcification: Limitations and Caveats for an Open Transcatheter Approach, Medicina, 10.3390/medicina58010093, 58:1, (93) Enta Y and Nakamura M (2021) Transcatheter mitral valve replacement, Journal of Cardiology, 10.1016/j.jjcc.2020.10.020, 77:6, (555-564), Online publication date: 1-Jun-2021. Guerrero M, Wang D, Eleid M, Rihal C, O'Neill W and Feldman T (2021) Edwards SAPIEN in Native Mitral Annular Calcification (MAC) Transcatheter Mitral Valve Therapies, 10.1002/9781119763741.ch22, (251-260), Online publication date: 26-Apr-2021. Alexis S, Malik A, El‐Eshmawi A, George I, Sengupta A, Kodali S, Hahn R, Khalique O, Zaid S, Guerrero M, Bapat V, Leon M, Adams D and Tang G (2021) Surgical and Transcatheter Mitral Valve Replacement in Mitral Annular Calcification: A Systematic Review, Journal of the American Heart Association, 10:7, Online publication date: 6-Apr-2021. Guerrero M, Eleid M and Rihal C (2021) Mitral valve-in-MAC Handbook of Structural Heart Interventions, 10.1016/B978-0-323-67278-8.00027-2, (209-222), . Gheorghe L, Brouwer J, Wang D, Wunderlich N, Rana B, Rensing B, Eefting F, Timmers L and Swaans M (2020) Current Devices in Mitral Valve Replacement and Their Potential Complications, Frontiers in Cardiovascular Medicine, 10.3389/fcvm.2020.531843, 7 Guerrero M, Wang D, Pursnani A, Eleid M, Khalique O, Urena M, Salinger M, Kodali S, Kaptzan T, Lewis B, Kato N, Cajigas H, Wendler O, Holzhey D, Pershad A, Witzke C, Alnasser S, Tang G, Grubb K, Reisman M, Blanke P, Leipsic J, Williamson E, Pellikka P, Pislaru S, Crestanello J, Himbert D, Vahanian A, Webb J, Hahn R, Leon M, George I, Bapat V, O'Neill W and Rihal C (2020) A Cardiac Computed Tomography–Based Score to Categorize Mitral Annular Calcification Severity and Predict Valve Embolization, JACC: Cardiovascular Imaging, 10.1016/j.jcmg.2020.03.013, 13:9, (1945-1957), Online publication date: 1-Sep-2020. Chen Y, Hu J, Wu S, Zhang S, Wu K, Wang W and Zhou Y (2020) Transcatheter Mitral Valve Replacement for Treating Native Mitral Valve Disease: Current Status, Texas Heart Institute Journal, 10.14503/THIJ-18-6650, 47:4, (271-279), Online publication date: 1-Aug-2020. Testa L, Popolo Rubbio A, Casenghi M, Pero G, Latib A and Bedogni F (2019) Transcatheter Mitral Valve Replacement in the Transcatheter Aortic Valve Replacement Era, Journal of the American Heart Association, 8:22, Online publication date: 19-Nov-2019. Aziz W, Claridge S, Ntalas I, Gould J, Vecchi A, Razeghi O, Toth D, Mountney P, Preston R, Rinaldi C, Razavi R, Niederer S and Rajani R (2019) Emerging role of cardiac computed tomography in heart failure, ESC Heart Failure, 10.1002/ehf2.12479, 6:5, (909-920), Online publication date: 1-Oct-2019. Carino D, Agostinelli A, El Qarra S, Gripshi F and Nicolini F (2019) Mitral annulus calcification: current management and future challenges, Asian Cardiovascular and Thoracic Annals, 10.1177/0218492319867237, 27:7, (565-572), Online publication date: 1-Sep-2019. Desnos C, Iung B, Himbert D, Ducrocq G, Urena M, Cormier B, Brochet E, Ou P, Vahanian A and Bouleti C (2019) Temporal Trends on Percutaneous Mitral Commissurotomy: 30 Years of Experience, Journal of the American Heart Association, 8:13, Online publication date: 2-Jul-2019. Tuzcu E (2019) Trouble After Transcatheter Mitral Valve Replacement, JACC: Cardiovascular Interventions, 10.1016/j.jcin.2019.03.029, 12:13, (1280-1282), Online publication date: 1-Jul-2019. Russell H, Guerrero M, Salinger M, Manzuk M, Pursnani A, Wang D, Nemeh H, Sakhuja R, Melnitchouk S, Pershad A, Fang H, Said S, Kauten J, Tang G, Aldea G, Feldman T, Bapat V and George I (2019) Open atrial transcatheter mitral valve replacement in patients with mitral annular calcification, The Journal of Thoracic and Cardiovascular Surgery, 10.1016/j.jtcvs.2018.09.003, 157:3, (907-916), Online publication date: 1-Mar-2019. Banovic M and DaCosta M (2019) Degenerative Mitral Stenosis: From Pathophysiology to Challenging Interventional Treatment, Current Problems in Cardiology, 10.1016/j.cpcardiol.2018.03.004, 44:1, (10-35), Online publication date: 1-Jan-2019. Barker C and Reardon M (2018) Transcatheter aortic valve replacement with the Lotus ™ valve system , Future Cardiology, 10.2217/fca-2018-0044, 14:5, (367-373), Online publication date: 1-Sep-2018. Russell H, Guerrero M, Salinger M, Manzuk M, Pursnani A, Wang D, Nemeh H, Sakhuja R, Melnitchouk S, Pershad A, Fang H, Said S, Kauten J, Tang G, Aldea G, Feldman T, Bapat V and George I (2018) Open Atrial Transcatheter Mitral Valve Replacement in Patients With Mitral Annular Calcification, Journal of the American College of Cardiology, 10.1016/j.jacc.2018.07.033, 72:13, (1437-1448), Online publication date: 1-Sep-2018. Guerrero M, Urena M, Himbert D, Wang D, Eleid M, Kodali S, George I, Chakravarty T, Mathur M, Holzhey D, Pershad A, Fang H, O'Hair D, Jones N, Mahadevan V, Dumonteil N, Rodés-Cabau J, Piazza N, Ferrari E, Ciaburri D, Nejjari M, DeLago A, Sorajja P, Zahr F, Rajagopal V, Whisenant B, Shah P, Sinning J, Witkowski A, Eltchaninoff H, Dvir D, Martin B, Attizzani G, Gaia D, Nunes N, Fassa A, Kerendi F, Pavlides G, Iyer V, Kaddissi G, Witzke C, Wudel J, Mishkel G, Raybuck B, Wang C, Waksman R, Palacios I, Cribier A, Webb J, Bapat V, Reisman M, Makkar R, Leon M, Rihal C, Vahanian A, O'Neill W and Feldman T (2018) 1-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Severe Mitral Annular Calcification, Journal of the American College of Cardiology, 10.1016/j.jacc.2018.02.054, 71:17, (1841-1853), Online publication date: 1-May-2018. Karády J, Ntalas I, Prendergast B, Blauth C, Niederer S, Maurovich-Horvat P and Rajani R (2018) Transcatheter mitral valve replacement in mitral annulus calcification – "The art of computer simulation", Journal of Cardiovascular Computed Tomography, 10.1016/j.jcct.2017.12.007, 12:2, (153-157), Online publication date: 1-Mar-2018. Guerrero M, Wang D, Himbert D, Urena M, Pursnani A, Kaddissi G, Iyer V, Salinger M, Chakravarty T, Greenbaum A, Makkar R, Vahanian A, Feldman T and O'Neill W (2017) Short-term results of alcohol septal ablation as a bail-out strategy to treat severe left ventricular outflow tract obstruction after transcatheter mitral valve replacement in patients with severe mitral annular calcification, Catheterization and Cardiovascular Interventions, 10.1002/ccd.26975, 90:7, (1220-1226), Online publication date: 1-Dec-2017. Dahle G, Rein K and Fiane A (2017) Single centre experience with transapical transcatheter mitral valve implantation†, Interactive CardioVascular and Thoracic Surgery, 10.1093/icvts/ivx038, 25:2, (177-184), Online publication date: 1-Aug-2017. Partida R and Elmariah S (2017) Transcatheter Mitral Valve Interventions: Current Therapies and Future Directions, Current Treatment Options in Cardiovascular Medicine, 10.1007/s11936-017-0538-2, 19:5, Online publication date: 1-May-2017. Bashir M, Sigurdsson G, Horwitz P and Zahr F (2017) Simultaneous transfemoral aortic and transseptal mitral valve replacement utilising SAPIEN 3 valves in native aortic and mitral valves, EuroIntervention, 10.4244/EIJ-D-16-00953, 12:13, (1649-1652), Online publication date: 1-Jan-2017. Muthiah R (2017) Rheumatic Mineralization of Aortic Valve and Anterior Mitral Leaflet—A Case Report, Case Reports in Clinical Medicine, 10.4236/crcm.2017.64009, 06:04, (95-119), . Herrmann H and Chitwood W (2017) Transcatheter Mitral Valve Replacement Clears the First Hurdle ∗, Journal of the American College of Cardiology, 10.1016/j.jacc.2016.11.029, 69:4, (392-394), Online publication date: 1-Jan-2017. Hulman M, Bena M, Artemiou P, Gasparovic I, Hudec V, Rajani R and Bapat V (2016) Iterative Learning of Transcatheter Mitral Valve Replacement in Mitral Valve Annulus Calcification: Management and Prevention of Transcatheter Mitral Valve Replacement Dislocation, The Annals of Thoracic Surgery, 10.1016/j.athoracsur.2016.02.061, 102:4, (e287-e290), Online publication date: 1-Oct-2016. Ferrari E, Dvir D and Guerrero M (2016) Transcatheter mitral valve replacement in degenerated calcified native mitral valves: is the currently available technology suitable?, European Journal of Cardio-Thoracic Surgery, 10.1093/ejcts/ezw188, 50:3, (391-395), Online publication date: 1-Sep-2016. Guerrero M, Dvir D, Himbert D, Urena M, Eleid M, Wang D, Greenbaum A, Mahadevan V, Holzhey D, O'Hair D, Dumonteil N, Rodés-Cabau J, Piazza N, Palma J, DeLago A, Ferrari E, Witkowski A, Wendler O, Kornowski R, Martinez-Clark P, Ciaburri D, Shemin R, Alnasser S, McAllister D, Bena M, Kerendi F, Pavlides G, Sobrinho J, Attizzani G, George I, Nickenig G, Fassa A, Cribier A, Bapat V, Feldman T, Rihal C, Vahanian A, Webb J and O'Neill W (2016) Transcatheter Mitral Valve Replacement in Native Mitral Valve Disease With Severe Mitral Annular Calcification, JACC: Cardiovascular Interventions, 10.1016/j.jcin.2016.04.022, 9:13, (1361-1371), Online publication date: 1-Jul-2016. November 2015Vol 8, Issue 11 Advertisement Article InformationMetrics © 2015 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.115.003031PMID: 26553700 Manuscript receivedJuly 28, 2015Manuscript acceptedOctober 15, 2015Originally publishedNovember 9, 2015 Keywordsmitral valvemitral annular calcificationtranscatheterhumansPDF download Advertisement SubjectsCatheter-Based Coronary and Valvular Interventions
Referência(s)