Effects of Transapical Transcatheter Mitral Valve Implantation

Abstract

Purpose: In this study, transapical transcatheter mitral valve-in-valve implantation (TAMVI) was compared with surgical redo mitral valve replacement (SRMVR) in terms of clinical outcomes.Methods: We retrospectively identified patients with degenerated mitral bioprosthesis or failed annuloplasty rings who underwent redo SRMVR or TAMVI at our medical center. Clinical outcomes were based on echocardiography results.Results: We retrospectively identified patients with symptomatic mitral bioprosthetic valve dysfunction (n = 58) and failed annuloplasty rings (n = 14) who underwent redo SRMVR (n = 36) or TAMVI (n = 36). The Society of Thoracic Surgeons Predicted Risk of Mortality scores were higher in the TAMVI group (median: 9.52) than in the SRMVR group (median: 5.59) (p-value = 0.02). TAMVI patients were more severe in New York Heart Association (p-value = 0.04). The total procedure time (skin to skin) and length of stay after procedures were significantly shorter in the TAMVI group, and no significant difference in mortality was noted after adjustment for confounding factors (p-value = 0.11). The overall mean mitral valve pressure gradient was lower in the TAMVI group than in the SRMVR group at 24 months (p < 0.01). Both groups presented a decrease in the severity of mitral and tricuspid regurgitation at 3–24 months.Conclusions: In conclusion, the statistical analysis is still not robust enough to make a claim that TAMVI is an appropriate alternative. The outcome of the patient appears only to be related to the patient's pre-operative STS score. Additional multi-center, longitudinal studies are warranted to adequately assess the effect of TAMVI.

Valve-in-valve/valve-in-ring transcatheter mitral valve implantation vs. redo surgical mitral valve replacement for patients with failed bioprosthetic valves or annuloplasty rings: A systematic review and meta-analysis

“…A total of 3,890 articles published between January 2015 and August 2022 were initially screened by title and abstract, of which 141 publications were possibly related and retrieved as full text. Ten articles [ 10 , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] ] satisfied our final inclusion criteria ( Fig. 1 ).…”

“…Historically, TMVI has been related to a higher incidence of LVOTO than redo SMVR [ 30 , 31 ]. Studies [ 17 , 18 , 20 ] reported no marked variance in the risk of postoperative LVOTO between the ViV/ViR TMVI group and the redo SMVR group. Simard et al [ 14 ] reported that transcatheter heart valve durability was excellent, with a consistent mean left ventricular outflow gradient during a 3-year follow-up.…”

Utilization of Two- and Three-Dimensional Transesophageal Echocardiography in Successfully Guiding Transcatheter Mitral Valve in Bioprosthetic Mitral Valve/Mitral Ring Implantation without Complications in Patients with Thrombus in Left Atrium/Left Atrial Appendage

“…The transcatheter MV implantation procedure was conducted in a standard manner under general anesthesia in all patients using the transapical approach [ 11 ]. All patients received anticoagulation with oral anticoagulants before and permanently after the procedure.…”

“…To the best of our knowledge, this is the first report describing a group of patients in whom transcatheter prosthetic MV implantation utilizing the transapical method was accomplished for a severely degenerated MV prosthesis or severe native MV stenosis status post a surgically inserted mitral annuloplasty ring with co-existing thrombus in the LAA and/or LA body. In a prior publication from our group, comparing surgical versus transcatheter MV in prosthetic MV patients, two patients with thrombus in the LA were listed in a table, but there was no further mention and no other details were provided in the published manuscript [ 11 ]. Since fluoroscopy does not visualize intracardiac thrombi, use of both 2D and 3DTEE was essential in finding the location and other attributes of the thrombi such as their size and extent in our patients and guiding the transcatheter procedure such that there was no contact with the thrombus at any time.…”

Utilization of two- and three-dimensional transesophageal echocardiography in successfully guiding transcatheter mitral valve in bioprosthetic mitral valve/mitral ring implantation without complications in patients with thrombus in left atrium/left atrial appendage.

“…The transcatheter MV implantation procedure was conducted in a standard manner under general anesthesia in all patients using the transapical approach. 11 Under both 2DTTE and 3DTEE vision, a guidewire was inserted into the left ventricle through a small incision in the fifth or sixth intercostal space in the apical area guided by 2DTTE. Using both 2D and 3DTEE guidance in addition to fluoroscopy, the guidewire was advanced into the malfunctioning bioprosthesis/ring.…”