Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry

Thourani, Vinod H.; Kelly, John; Cervantes, David; Vemulapalli, Sreekanth; Manandhar, Pratik; Forcillo, Jessica; Holmes, David R.; Cohen, David J.; Kirtane, Ajay J.; Kodali, Susheel; Leon, Martin B.; Babaliaros, Vasilis; Waksman, Ron; Satler, Lowell F.; Shults, Christian; Ben‐Dor, Itsik; Rogers, Toby; Kapadia, Samir; Reardon, M.; Malaisrie, S. Chris; Gleason, Thomas G.; Holper, Elizabeth M.; Bavaria, Joseph E.; Herrmann, Howard C.; Szeto, Wilson Y.; Carroll, John D.

doi:10.1016/j.athoracsur.2019.08.113

Cited by 2 publications

(5 citation statements)

References 33 publications

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“…In the TAVR registry, the incidence of paravalvular leakage (PVL) in TAVR with prior MVR (5.78%) was like in TAVR without prior MVR (4.91%). 10) In a multicenter analysis, grade 3 or 4 PVL immediately and 6 months after TAVR was similar (p = 0.999 and p = 0.495) both in patients with prior MVR (2.9% and 1.9%) and without prior MVR (4.2% and 0.9%). Mean THV pressure gradient immediately and 6 months after TAVR was slightly higher in patients with prior MVR (12.86 mmHg and 13.54 mmHg) than without prior MVR (11.23 mmHg and 10.53 mmHg) though statistically not significant (p = 0.144 and p = 0.062).…”

Section: Thv Dysfunctionmentioning

confidence: 84%

“…Amat-Santos et al 13) found no significant difference in the in-hospital mortality of 5.5% for 91 patients with prior MVR compared with 7.3% for 2323 without prior MVR (p = 0.514). Thourani et al 10) also reported no difference in the hospital mortality (3.7% vs. 4.1%, p = 0.478) or 30-day mortality (4.6% vs. 5.5%, p = 0.293) among patients with and without prior mitral valve surgery. There was significant higher 1-year mortality among patients with prior mitral valve surgery (20% vs. Fig.…”

Section: Mortalitymentioning

confidence: 95%

“…This might be also true for TAVR in patients with prior mitral valve replacement (MVR). Thourani et al 10) reported the results of TAVR after prior mitral valve surgery by TAVR registry. VARC-2 defined device success rate was significantly (p = 0.016) higher among patients with prior mitral valve surgery (93.4%) compared with patients without prior mitral valve surgery (90.1%).…”

Section: Thv Embolizationmentioning

confidence: 99%

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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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Section: Thv Dysfunctionmentioning

confidence: 84%

Section: Mortalitymentioning

confidence: 95%

Section: Thv Embolizationmentioning

confidence: 99%

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

Kobayashi

2021

Journal of Transcatheter Valve Therapies

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“…Our experience with the two reported index cases, similar to other reports and registry data included in a recent systematic review [ 15 ], suggests the feasibility of this course of action. Furthermore, it seems the presence of a PMV may not significantly increase short term mortality risk post-TAVR [ 9 , 11 ]. However, randomized clinical trial data and guideline recommendations are still lacking.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who have undergone previous mitral valve replacement (MVR) represent a subset that has largely been excluded from trials demonstrating clinical and survival benefit of TAVR [ 1 – 3 ]. Existing data on the post-MVR TAVR procedure are limited to case reports/series [ 4 – 7 ] and retrospective analyses [ 8 – 11 ]. This explains why current guidelines have no specific recommendations for this subpopulation.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter aortic valve replacement in patients with a pre-existing prosthetic mitral valve: a single center experience with two cases

Kushimo,

Yadav,

Pandey

et al. 2024

Egypt Heart J

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Background The performance of transcatheter aortic valve replacement (TAVR) in patients with pre-existing prosthetic mitral valves is technically challenging due to the potential interference between both prosthetic devices. At present, there are no clear recommendations for this patient subset due to their exclusion from clinical trials. We report our experience of two cases with pre-existing prosthetic mechanical mitral valves who underwent TAVR. Case presentation The first case was a 57 year old man with severe aortic stenosis and type 2 diabetes mellitus who had a mitral valve replacement 32 years ago. Operative mortality risk assessed by the Society for Thoracic Surgery (STS) Score was 1.7%, but he was considered high risk in view of previous cardiac surgery. Pre-procedure CT evaluation revealed favorable aortic root and femoral access anatomy with the mechanical mitral valve located 6.3 mm below the aortic annular plane. He underwent TAVR with a Medtronic Evolut R 29 mm self-expanding transcatheter heart valve via the femoral approach. The second case was a 66 year old lady who presented with severe aortic stenosis, atrial fibrillation and a history of mitral valve replacement 17 years ago for rheumatic mitral stenosis. Her STS score was 3.5%. Pre-procedure CT showed favorable aortic root and femoral access parameters with a mitral-aortic distance of 3.6 mm. TAVR was performed with a balloon expandable Myval 21.5 mm transcatheter heart valve via a transfemoral access. Both procedures were done successfully. Conclusion This report highlights the feasibility of TAVR in post-mitral valve replacement patients provided careful pre-procedural evaluation, and planning is done.

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Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry

Cited by 2 publications

References 33 publications

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

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

Transcatheter aortic valve replacement in patients with a pre-existing prosthetic mitral valve: a single center experience with two cases

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