Fatal prosthetic mitral valve encroachment during transcatheter aortic valve implantation

Acar, Berrin; Kuyumcu, Serdar; Aydın, Selahattin; Kara, Meryem; Karakurt, Mustafa; Özeke, Özcan; Demirkan, Burcu; Temizhan, Ahmet; Kisacik, Halil

doi:10.1016/j.ijcard.2014.12.125

Cited by 11 publications

(11 citation statements)

References 8 publications

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“…This study had satisfactory procedural success (96.8%). Although one case of THV interference with the mitral prosthesis occurred, the patient had a benign course, unlike previous cases [7]. In this particular case of our study, the THV impinged on one of the two mitral mechanical leaflets, partially interfering with the opening of the leaflet.…”

Section: Discussionmentioning

confidence: 53%

“…For patients who have undergone MVR and have a previously implanted mitral prosthesis, TAVI is considered technically challenging because the rigid housing or protruding stem of the prosthesis might interfere with the optimal positioning of the transcatheter heart valve (THV) and increase the risk of valve embolization [4–6]. Furthermore, the newly implanted THV could interfere with the preexisting mitral prosthesis [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Previously implanted mitral surgical prosthesis in patients undergoing transcatheter aortic valve implantation: Procedural outcome and morphologic assessment using multidetector computed tomography

et al. 2019

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Transcatheter aortic valve implantation (TAVI) in the presence of a preexisting mitral prosthesis is challenging and its influence on the morphology of mitral prosthesis and the positioning of transcatheter heart valve (THV) is unknown. We assessed the feasibility of TAVI for patients with preexisting mitral prostheses, its influence on mitral prosthesis morphology, and the positional interaction between a newly implanted THV and mitral prosthesis using serial multidetector computed tomography (MDCT). Thirty-one patients with preexisting mitral prosthesis undergoing TAVI were included. MDCT was performed before and after TAVI. Thirty patients successfully underwent TAVI without interference from preexisting mitral prosthesis. Although opening disturbance of the mechanical mitral prosthesis by the THV edge was observed in 1 patient, the patient was managed conservatively. No THV embolization occurred. THV shift during deployment occurred in 9 patients and was predicted by a larger aortic annulus area (odds ratio: 1.24 per 10 mm2, 1.03–1.49, p = 0.02), possibly because of large THVs. The mitral mean pressure gradient was slightly higher after TAVI (3.7 vs. 4.3 mmHg, p = 0.002), whereas the mitral regurgitation grade was similar. MDCT showed that the size of the mitral prosthesis housing was unchanged after TAVI. The median distance between the mitral prosthesis and THV was 2.6 mm. The postprocedural angle between the mitral prosthesis and THV was larger than the preprocedural angle between the mitral prosthesis and the left ventricular outflow tract (64° vs. 61°, p = 0.03). Thus, TAVI is feasible in the case of preexisting mitral prosthesis. Serial MDCT demonstrated favorable THV positioning and unchanged mitral prosthesis morphology after TAVI.

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Previously implanted mitral surgical prosthesis in patients undergoing transcatheter aortic valve implantation: Procedural outcome and morphologic assessment using multidetector computed tomography

et al. 2019

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“…Acar and colleagues [5] recently described a similar case wherein interference with the function of a singletilting disc mitral prosthesis was evident immediately after deployment of a balloon-expandable valve. The patient's hemodynamic status became depressed, and she was taken to the intensive care unit, where echocardiography demonstrated an increased gradient across the mitral prosthesis and thrombus in the left atrium.…”

Section: Commentmentioning

confidence: 97%

Impingement of Single-Tilting Disc Mitral Prosthesis During Transcatheter Aortic Valve Replacement

Squiers

Hebeler

DiMaio

et al. 2016

The Annals of Thoracic Surgery

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An 80-year-old woman with a medical history of mitral valve replacement with single-tilting disc prosthesis underwent transcatheter aortic valve replacement (TAVR). The tilting disc was noted to have abnormal motion after re-ballooning of the TAVR valve. Cardiopulmonary bypass was initiated, and the procedure was converted to surgical aortic valve replacement. After removal of the TAVR valve, the tilting disc moved freely. Although TAVR in patients with mitral prostheses is technically feasible, particular caution is necessary, and postdeployment dilation should be avoided.

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“…11) These patients underwent prior MVR with single tilting disc valve. [14][15][16] Major orifice was opening to the left ventricular outflow tract (anti-anatomical position), and the disc was impinged by THV or tissue of aorto-mitral curtain. Sudden hemodynamic deterioration occurred.…”

Section: Interference Of Tavi Device To Mitral Valve Prosthesismentioning

confidence: 99%

“…14) The second patient died without any treatment after SAPIEN XT valve implantation. 15) The third patient converted to surgical aortic valve replacement after SAPIEN 3 implantation, and discharged home on postoperative day 8. 16) It is believed by most cardiac surgeons that anatomical implantation (major orifice toward the posterior leaflet) of a single tilting disc valve in the mitral position favors optical hemodynamic flow without disturbance of left ventricular ejection.…”

Section: Interference Of Tavi Device To Mitral Valve Prosthesismentioning

confidence: 99%

Safety of Transcatheter Aortic Valve Replacement in Patients with Prosthetic Mitral Valve

Kobayashi

2021

Journal of Transcatheter Valve Therapies

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Transcatheter aortic valve replacement (TAVR) has become an alternative procedure for treating aortic stenosis in patients with advanced age and comorbidities. Although patients with previous surgical mitral valve replacement (MVR) are also indicated for TAVR, there might increase the risk of malposition of device, stuck of mechanical valve leaflet, or paravalvular leakage (PVL). My objective is to review the risk of TAVR in patients with prosthetic mitral valve with some experimental study. TAVR patients with prosthetic mitral valve had similar mortality and morbidity compared with TAVR without prosthetic mitral valve. Transcatheter heart valve (THV) migration or interaction to mitral prosthetic valve was rare. Interference of THV with prosthetic valve was high when aorto-mitral angle was less than 90° and mitral prosthesis distance was less than 7 mm in my experimental study in vitro. Anatomically implanted bileaflet valve (oriented like anterior and posterior mitral valve) or anti-anatomically implanted single tilting disc valve (major orifice opening to the left ventricular outflow tract) is a risk of impingement and stuck with THV. Preoperative evaluation of aorto-mitral anatomy and prosthetic valve implantation method by multi-modalities are important.

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Fatal prosthetic mitral valve encroachment during transcatheter aortic valve implantation

Cited by 11 publications

References 8 publications

Previously implanted mitral surgical prosthesis in patients undergoing transcatheter aortic valve implantation: Procedural outcome and morphologic assessment using multidetector computed tomography

Previously implanted mitral surgical prosthesis in patients undergoing transcatheter aortic valve implantation: Procedural outcome and morphologic assessment using multidetector computed tomography

Impingement of Single-Tilting Disc Mitral Prosthesis During Transcatheter Aortic Valve Replacement

Safety of Transcatheter Aortic Valve Replacement in Patients with Prosthetic Mitral Valve

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