Prosthetic Mitral Surgical Valve in Transcatheter Aortic Valve Replacement Recipients

Amat‐Santos, Ignacio J.; Cortés, Carlos; Nombela‐Franco, Luis; Muñoz-García, Antonio J.; Lezo, José Suárez de; Gutiérrez‐Ibañes, Enrique; Serra, Violeta; Larman, Mariano; Moreno, Raúl; Hernández, José M. de la Torre; Puri, Rishi; Jimenez-Quevedo, Pilar; Garcı́a, José Marı́a Hernández; Alonso‐Briales, Juan H.; García, Bruno; Lee, Dae-Hyun; Rojas, Paol; Sevilla, Teresa; Goncalves, Renier; Vera, Silvio; Gómez, Itzíar; Rodés‐Cabau, Josep; Román, José Alberto San

doi:10.1016/j.jcin.2017.07.045

Cited by 26 publications

(23 citation statements)

References 21 publications

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“…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%

“…One registry and several case series have reported the feasibility of TAVI in this situation [4–6,9–16]. A previous report demonstrated favorable outcomes in 91 patients with preexisting mitral prostheses who underwent TAVI [6]. It also reported a relatively high occurrence of THV embolization (6.7%) and suggested that a short distance between the aortic annulus and mitral prosthesis was a potential risk factor for THV embolization.…”

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: Introductionmentioning

confidence: 99%

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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“…Transcatheter aortic valve replacement (TAVR) is recommended in the treatment of severe aortic stenosis in patients who are at high or prohibitive surgical risk[1]. Several patients with previous mitral valve surgery have been reported to be treated with TAVR[2-6]. However, TAVR has been performed off-label to treat patients with pure aortic regurgitation due to the absence of annular or leaflet calcification for device anchoring.…”

Section: Introductionmentioning

confidence: 99%

Transfemoral aortic valve implantation in the case of pre-existing mitral prosthesis and pure aortic regurgitation: A case report

Erdem

Zencirci

Özden

et al. 2019

WJCC

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BACKGROUNDTranscatheter aortic valve replacement (TAVR) is recommended in patients with severe aortic stenosis who have high surgical risk. However, in the pre-existing mechanical mitral valve prosthesis and natural pure aortic regurgitation, TAVR is relatively contraindicated. In this report, we described one case of TAVR with native aortic regurgitation in the presence of mechanical mitral valve prosthesis.CASE SUMMARYA 64-year-old man with a medical history of mitral valve replacement had severe dyspnea and was symptomatic even at rest for 3 mo. His echocardiography showed severe native pure aortic regurgitation. His euroscore was 15. A TAVR procedure with an evolut R was planned. A 34 mm evolut R was placed by transesophageal echocardiography. The mitral prosthesis was functioning normally, and mild-moderate paravalvular leakage was evident by transesophageal echocardiography. The patient recovered without any complication. At 1 mo follow up, the patient was well, and no paravalvular leakage was noted.CONCLUSIONTAVR for pure aortic regurgitation in the presence of prosthetic mitral valve can be a safe procedure.

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“…The so-called "TAVI fever" has often led to the use of this promising technology in clinical conditions with unproven efficacy attending to current scientific evidence. Very old [1], multi-valvular [2][3][4], or oncological patients [5] represent some of the challenging scenarios where the use of TAVI might be attractive but remains empirical. Tokarek et al[6] explored one important scenario still under-investigated despite the fact that one in four TAVI recipients present this condition: the presence of prior sternotomy for cardiac surgery.It is well-known that sternotomy is relatively safe by itself but not harmless [7].…”

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confidence: 99%

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confidence: 99%

Transcatheter aortic valve implantation: the optimal alternative to cardiac reoperation also from the patient’s perspective

Amat‐Santos¹,

Catalá²

2018

Kardiol Pol

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Article Tokarek et al., see p. 838The spread of transcatheter aortic valve implantation (TAVI) technologies to alternative scenarios in the near future is unquestionable, but several shortcomings still exist. The so-called "TAVI fever" has often led to the use of this promising technology in clinical conditions with unproven efficacy attending to current scientific evidence. Very old [1], multi-valvular [2][3][4], or oncological patients [5] represent some of the challenging scenarios where the use of TAVI might be attractive but remains empirical. Tokarek et al.[6] explored one important scenario still under-investigated despite the fact that one in four TAVI recipients present this condition: the presence of prior sternotomy for cardiac surgery.It is well-known that sternotomy is relatively safe by itself but not harmless [7]. Interestingly, the authors performed not only an assessment of prognostic outcomes, but they also gave a hint of the patient's perception of the procedure through prospective evaluation with quality-of-life scales. This has particular value in comparing conventional cardiac surgery and transcatheter technologies in a population that have experienced both kinds of procedures. Despite the relatively small sample, significant differences were found in global mortality, favouring TAVI in the long term. Also, better results in all evaluated items regarding quality of life (mobility, self-care, pain, etc.) were present, although statistical significance was not reached. The fact that ~20% of the patients were treated through transapical/transaortic approach should be taken into consideration to explain this. In the current series, this proportion is usually below 10% and, even though the authors suggest that both transapical and transfemoral approaches are reasonable in patients with previous cardiac operations, we should keep in mind that the transapical approach also requires a thoracotomy, which has been previously associated with a higher degree of discomfort for the patient, more periprocedural complications, and higher mortality [8]. As highlighted by the authors (and this is the main message from this work, from my perspective), we need to start wondering which alternatives are preferred by well-informed patients; and this information should include the consequences in all aspects related to the quality of life post-intervention. In this regard, alternative approaches to transapical/transaortic access in poor candidates to transfemoral access should be evaluated; transaxillary approach is a very good option with fewer induced comorbidities for the patient [9], but the investigation from Tokarek et al. [6] makes us wonder if we have enough information regarding the perception of the patient with this approach as compared to others. Additionally, more than 80% of the patients with prior sternotomy had undergone coronary artery bypass grafting. Probably, left subclavian approach was not used due to the risk of compromising the left internal mammary artery, whereas the right approach is empi...

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Prosthetic Mitral Surgical Valve in Transcatheter Aortic Valve Replacement Recipients

Cited by 26 publications

References 21 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

Transfemoral aortic valve implantation in the case of pre-existing mitral prosthesis and pure aortic regurgitation: A case report

Transcatheter aortic valve implantation: the optimal alternative to cardiac reoperation also from the patient’s perspective

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