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

Eleid, Mackram F.; Whisenant, Brian; Cabalka, Allison K.; Williams, Mathew; Nejjari, Mohammed; Attias, David; Fam, Neil; Amoroso, Nicholas; Foley, Thomas A.; Pollak, Peter; Alli, Oluseun; Pislaru, Sorin V.; Said, Sameh M.; Dearani, Joseph A.; Rihal, Charanjit S.

doi:10.1016/j.jcin.2017.08.014

Cited by 135 publications

(108 citation statements)

References 12 publications

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“…Valve replacement was performed under general anesthesia in the cardiac catheterization laboratory as previously described. 3,4,9 Briefly, at procedure onset, the right common femoral vein was first accessed using either a 14-or a 16-French sheath. Under TEE guidance, a pacing catheter was positioned in the right ventricle.…”

Section: Mitral Valve-in-valve and Valve-in-ring Replacementmentioning

confidence: 99%

“…Such degeneration is often characterized by leaflet thickening, restricted leaflet motion, or flail leaflet and can present as prosthetic mitral stenosis, regurgitation, or a mixed phenotype. In the setting of elevated surgical risk and need for intervention, transseptal transcatheter mitral valve‐in‐ring/−valve replacement (TMVR) has offered a convincing alternative with relatively reduced morbidity, improved recovery, and shorter hospitalizations in selected patients with prosthetic mitral valve stenosis and/or regurgitation …”

Section: Introductionmentioning

confidence: 99%

“…In the setting of elevated surgical risk and need for intervention, transseptal transcatheter mitral valve-in-ring/−valve replacement (TMVR) has offered a convincing alternative with relatively reduced morbidity, improved recovery, and shorter hospitalizations in selected patients with prosthetic mitral valve stenosis and/or regurgitation. [2][3][4][5][6] Although TMVR interventions have become increasingly commonplace, the potentially differing responses of unique patient populations to TMVR have not been elucidated fully. To this end, this study aimed to assess and compare the immediate hemodynamic changes effected by mitral TMVR and the attendant clinical outcomes in patients with mitral valve prostheses that had developed principally either stenotic or regurgitant prosthetic degeneration.…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic and clinical response to transseptal mitral valve‐in‐valve and valve‐in‐ring

Lloyd

Joseph

Cabalka

et al. 2019

Cathet Cardio Intervent

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Objective To understand the clinical and hemodynamic response of patients with stenotic versus regurgitant prosthetic mitral valve degeneration to transseptal transcatheter mitral valve‐in‐ring/‐valve replacement (TMVR). Background Patients with prosthetic mitral valve repair/replacement failure frequently present high‐risk surgical challenges. TMVR has been employed as an alternative to surgery. Methods Forty‐four patients with stenotic/regurgitant degeneration of prior prosthetic mitral annuloplasty and replacement (38) underwent mitral TMVR. Clinical, echocardiographic, and invasive hemodynamic monitoring was conducted at baseline and follow‐up. Results Relative to patients with regurgitant degeneration (28), patients with stenotic degeneration had baseline higher mitral valve gradients (12 ± 4 vs. 7 ± 3 mmHg, p < 0.01) and smaller areas (1.0 ± 0.4 vs. 1.5 ± 0.4 cm2, p = 0.01). TMVR yielded significant reduction in left atrial v‐wave pressures in stenotic and regurgitant cohorts (−7 ± 11, p = 0.03, and −11 ± 12 mmHg, p < 0.01, respectively) and significant, sustained symptomatic improvement. Intracardiac pressures overall, including left ventricular end diastolic pressures, remained elevated. Conclusion Despite baseline differences in valvular disease, TMVR leads to significant hemodynamic and clinical improvement in both stenotic and regurgitant prosthetic mitral valve disease. In both cohorts, TMVR reduced intracardiac pressures to similar postprocedural levels, but pressures remained supranormal. This outcome suggests a multifactorial process defines the pathophysiology of patients undergoing TMVR, including contributions from prosthetic degeneration, changes in left atrial compliance, and diastolic dysfunction, and highlights the need to consider such factors in patient evaluation and treatment.

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Section: Mitral Valve-in-valve and Valve-in-ring Replacementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hemodynamic and clinical response to transseptal mitral valve‐in‐valve and valve‐in‐ring

Lloyd

Joseph

Cabalka

et al. 2019

Cathet Cardio Intervent

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“…In certain patients with significant comorbidities, redo surgery may be associated with an early mortality as high as 5%–12% . In recent years, transcatheter valve‐in‐valve options have become available for such high‐risk individuals . These transcatheter valves are most often implanted through a transseptal approach which is less invasive than the transapical route as demonstrated in our patient .…”

Section: Discussionmentioning

confidence: 84%

Commissural fusion as etiology of bioprosthetic mitral stenosis in a patient with rheumatic heart disease

et al. 2020

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We report commissural fusion as a unique morphologic etiology of early bioprosthetic mitral valve failure in a woman with a history of rheumatic mitral stenosis. She had undergone mitral valve replacement with a 25‐mm Edwards Magna Ease bovine pericardial bioprosthesis 3 years earlier and presented with progressive dyspnea. Transesophageal echocardiography revealed severe bioprosthetic stenosis due to commissural fusion. She underwent percutaneous valve‐in‐valve implantation with a 26‐mm Edwards Sapien 3 prosthesis. Marked symptomatic improvement was noted postprocedurally. We speculate that commissural fusion may be a unique pathologic feature of failing bioprosthetic valves in patients with prior rheumatic mitral valve disease.

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“…Their reported 1 year mortality was lower at 9.6% with mild or less MR in all with average median follow‐up of 753 days . Another series of 60 predominantly transseptal valve‐in‐valve procedures reported a 97% success rate with similar improvements in gradient; 1 year mortality was reported at 14% with gradients of 7.3 ± 2.5 mmHg and no worse than mild MR …”

Section: Discussionmentioning

confidence: 97%

Long‐term outcomes of melody valve‐in‐valve implantation for bioprosthetic mitral valve dysfunction

Joseph

Eleid

Cabalka

et al. 2018

Cathet Cardio Intervent

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Objectives: This study reports long-term outcomes percutaneous Melody valve (Medtronic, Minneapolis, Minnesota) valve-in-valve therapy in patients with prosthetic valve dysfunction.Background: Repeat valve surgery is associated with high morbidity and mortality. Transcatheter mitral valve-in-valve is a promising alternative in patients at high-risk for cardiac surgery. Methods:We conducted a retrospective cohort analysis of 13 patients who underwent Melody valve-in-valve for bioprosthetic dysfunction from July 2011 to October 2013.Results: Mean age was 74.4 years, 46% male, and STS score 13.5 AE 6.8%. All patients had NYHA class 3 or 4 symptoms with improvement to class 1 or 2 in 82% post procedure. Median follow-up was 4.5 years with longest follow-up of 5.5 years. Thirty-day mortality was 15.4% with 1-year mortality of 25% and no other reported deaths until 4.5 years. 76.9% of patients had mitral gradient of 5 mmHg or less immediately postprocedure. One patient required repeat valve procedure for structural deterioration at 4.4 years. At 1, 3, and 5 year follow-ups 75% of patients were NYHA class 1 or 2, mean gradients were 4.5 AE 0.6, 6.8 AE 0.5, and 7.5 AE 0.7, respectively. Using 4-point scale, mitral regurgitation postprocedure was 0.8 AE 0.6. At 1, 3, and 5 years this increased to 1.0 AE 1.1, 1.3 AE 1.3, and 2.5 AE 2.1, respectively.Conclusions: Melody valve-in-valve therapy was effective with 1-year symptomatic improvement. Prosthesis deterioration requiring repeat intervention was observed in one patient. Larger cohorts with multicenter registries are needed to determine the role of this percutaneous valvein-valve therapy as valve technology and procedural techniques improve.

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

Cited by 135 publications

References 12 publications

Hemodynamic and clinical response to transseptal mitral valve‐in‐valve and valve‐in‐ring

Hemodynamic and clinical response to transseptal mitral valve‐in‐valve and valve‐in‐ring

Commissural fusion as etiology of bioprosthetic mitral stenosis in a patient with rheumatic heart disease

Long‐term outcomes of melody valve‐in‐valve implantation for bioprosthetic mitral valve dysfunction

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