Transcatheter Aortic and Mitral Valve Replacement in a Patient With Critical Aortic and Mitral Valve In-Ring Stenosis

Yaryura, Ricardo; Rehman, Atiq; Morsli, Hakim; Hussain, Nasir

doi:10.1016/j.jcin.2015.03.040

Cited by 4 publications

(4 citation statements)

References 4 publications

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“…From 2009 to March 31, 2018, 66 published reports describing 172 patients undergoing TMVIV implantation for degenerated mitral bioprostheses and 35 articles describing 73 patients undergoing TMVIR implantation for failed annuloplasty rings were identified (Figure ). The patients were diagnosed with MR, MS, or mixed lesions according to the articles but the failure modes of 34 patients were unknown.…”

Section: Resultsmentioning

confidence: 99%

“…The three different positions of the ES valve are as follows: (1) less atrium more ventricle: 1/3 in the atrium and 2/3 in the ventricle 75,101,104 or 40% in the atrium and 60% in the ventricle 90,105 ; (2) half above and half below the mitral ring 95 ; (3) more atrium less ventricle: 40% ventricular and 60% atrial configuration. 92 Two articles reported the position of the Melody valve as follows: 20% in the atrium and 80% in the ventricle 98 and 40% in the atrium and 60% in the ventricle. 100 All patients had successful TMVIR surgery and good clinical outcomes before discharge, and no migrations occurred.…”

Section: Optimal Valve Positionsmentioning

confidence: 99%

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Transcatheter mitral valve implantation for degenerated mitral bioprostheses or failed surgical annuloplasty rings: A systematic review and meta-analysis

Chen

Cheng

et al. 2018

J Card Surg

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BackgroundTranscatheter mitral valve‐in‐valve (TMVIV) and valve‐in‐ring (TMVIR) implantation for degenerated mitral bioprostheses and failed annuloplasty rings have recently emerged as treatment options for patients deemed unsuitable for repeat surgery.MethodsA systematic literature review was conducted to summarize the data regarding the baseline characteristics and clinical outcomes of patients undergoing TMVIV and TMVIR procedures.ResultsA total of 245 patients (172 patients who underwent TMVIV surgery and 73 patients who underwent TMVIR surgery) were included in the study; 93.5% of patients experienced successful TMVIV or TMVIR implantation. The mortality rates at discharge, 30 days, and 6 months were 5.7%, 8.1%, and 23.4%, respectively. The transapical (TA) access route was used in most procedures (55.2%). The TA and transseptal (TS) access routes resulted in similar outcomes. No significant differences were observed in the short‐term outcomes between the patients who developed mitral stenosis versus mitral regurgitation as the mode of failure.ConclusionsTMVIV and TMVIR implantation for degenerated mitral bioprostheses and failed annuloplasty rings are safe and effective. Both procedures, via TA or TS access, can result in excellent short‐term clinical outcomes in patients with mitral stenosis or regurgitation, but long‐term follow‐up data are currently lacking to determine the durability of these procedures.

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Section: Resultsmentioning

confidence: 99%

Section: Optimal Valve Positionsmentioning

confidence: 99%

Transcatheter mitral valve implantation for degenerated mitral bioprostheses or failed surgical annuloplasty rings: A systematic review and meta-analysis

Chen

Cheng

et al. 2018

J Card Surg

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“…Transcatheter mitral valve replacement (TMVR) offers a less invasive treatment alternative to redo cardiac surgery, particularly in high-risk patients with degenerated mitral bioprostheses and failed annuloplasty rings ( 47 ). Clinical experience with bivalvular transcatheter procedures, however, is still limited ( 48 , 49 ). The success of a combined approach with transcatheter mitral valve repair performed at the time of TAVR has been reported in several studies ( 50 , 51 ).…”

Section: Treatment Strategies In Patients With Severe Aortic Stenosismentioning

confidence: 99%

Transcatheter Aortic Valve Replacement and Concomitant Mitral Regurgitation

Stähli

Reinthaler

Leistner

et al. 2018

Front. Cardiovasc. Med.

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Mitral regurgitation frequently coexists in patients with severe aortic stenosis. Patients with moderate to severe mitral regurgitation at the time of transcatheter aortic valve replacement are at increased risk of future adverse events. Whether concomitant mitral regurgitation is independently associated with worse outcomes after TAVR remains a matter of debate. The optimal therapeutic strategy in these patients—TAVR with evidence-based heart failure therapy, combined TAVR and transcatheter mitral valve intervention, or staged transcatheter therapies—is ill-defined, and guideline-based recommendations in patients at increased risk for open heart surgery are lacking. Hence, a thorough evaluation of the aortic and mitral valve anatomy and function, along with an in-depth assessment of the patients' baseline risk profile, provides the basis for an individualized treatment approach. The aim of this review is therefore to give an overview of the current literature on mitral regurgitation in TAVR, focusing on different diagnostic and therapeutic strategies and optimal clinical decision making.

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“…However, only limited clinical experience is available so far and peri-procedural complication rate may be significant [2, 3]. …”

Section: Introductionmentioning

confidence: 99%

Pitfalls in TAMVI: experience with the repositionable Lotus® Valve System

Heinisch

Praz

Winkler

et al. 2017

J Cardiothorac Surg

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BackgroundSimultaneous transapical implantation of transcatheter heart valves in the native mitral and aortic position may be considered as an alternative to surgical valve replacement in high-risk patients presenting with combined valve disease.Case presentationA 59-year-old female with severe aortic stenosis, severe mitral stenosis with mild mitral insufficiency, persistent atrial fibrillation, severe chronic obstructive pulmonary disease and NYHA class of IV was evaluated by our interdisciplinary heart team. Due to the calculated Euroscore II, logistic Euroscore with 10% and 17% a decision was made towards a transapical TAVI approach. The implantation of a Sapien 3 (Edwards Lifesciences) valve in the aortic position was performed and the perioperative TEE showed a good result. The preoperative imaging revealed a narrow LVOT with risk for post interventional left ventricular outflow tract obstruction. Accordingly, it was decided against the use of balloon-expanding valves for the mitral valve position in the interdisciplinary team, as it is not repositionable. Instead, it was decided for the use of a Lotus (Boston Scientific) valve, as it is repositionable and therefore possible to retract in case of LVOT obstruction. In the present case of double valve intervention, the implantation attempt of a fully repositionable transcatheter heart valve into the native mitral annulus resulted in acute LVOT obstruction requiring immediate removal of the device. The patient was extubated and experienced uneventful postoperative recovery.ConclusionsThe case shows that improved preoperative work-up is necessary for better prediction of significant LVOT obstruction following transcatheter mitral valve implantation. In borderline cases, the use of a fully repositionable device is preferred.

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Transcatheter Aortic and Mitral Valve Replacement in a Patient With Critical Aortic and Mitral Valve In-Ring Stenosis

Cited by 4 publications

References 4 publications

Transcatheter mitral valve implantation for degenerated mitral bioprostheses or failed surgical annuloplasty rings: A systematic review and meta-analysis

Transcatheter mitral valve implantation for degenerated mitral bioprostheses or failed surgical annuloplasty rings: A systematic review and meta-analysis

Transcatheter Aortic Valve Replacement and Concomitant Mitral Regurgitation

Pitfalls in TAMVI: experience with the repositionable Lotus® Valve System

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