Transcatheter Mitral Valve Replacement in the Transcatheter Aortic Valve Replacement Era

Testa, Luca; Rubbio, Antonio Popolo; Casenghi, Matteo; Pero, Gaetano; Latib, Azeem; Bedogni, Francesco

doi:10.1161/jaha.119.013352

Cited by 51 publications

(57 citation statements)

References 58 publications

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“…However, our vast experience with trans-apical access in TAVR has shown that this approach is associated with inferior outcomes compared to trans-femoral access (15). For example, transapical access has been associated with a higher degree of myocardial damage and harmful effects of the thoracotomy compared to trans-femoral access in the TAVR literature (1,16). In addition, trans-apical access is associated with higher rates of pleural effusion, bleeding, atrial fibrillation and prolonged intubation (15)(16)(17).…”

Section: Clinical Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Surgical mitral valve replacement remains the standard of care for patients with severe mitral valve disease when mitral valve repair is not feasible (1). Subsequent degeneration of the bioprosthetic valve however, can limit long-term success (1). When structural valve degeneration occurs, some patients may ultimately require repeat surgical mitral valve replacement, a high-risk operation associated with high mortality and major complications (2).…”

Section: Introductionmentioning

confidence: 99%

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A step-by-step guide to transseptal valve-in-valve transcatheter mitral valve replacement

Harloff¹,

Chowdhury²,

Hirji³

et al. 2021

Ann Cardiothorac Surg

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With the recent success of transcatheter aortic valve replacement (TAVR), transcatheter options for the management of mitral valve pathology have also gained considerable attention. Valve-in-valve (ViV) transcatheter mitral valve replacement (TMVR) is one such technique that has emerged as a safe and effective therapeutic option for patients with degenerated mitral valve bioprostheses at high-risk for repeat surgical mitral valve replacement. Several access strategies, including trans-apical, transseptal, trans-jugular, and trans-atrial access have been described for ViV-TMVR. Initial experiences were performed primarily via a trans-apical approach through a left mini-thoracotomy because it offers direct access and coaxial device alignment. With the advancements in TMVR technology, such as the development of smaller delivery catheters with high flexure capabilities, the transseptal approach via the femoral vein has emerged as the preferred option. This technique offers the advantages of a totally percutaneous approach, avoids the need to enter the thoracic cavity or pericardial space, and provides superior outcomes compared to a trans-apical approach. In this review, we outline key aspects of patient selection, imaging, procedural techniques, and examine contemporary clinical outcomes of transseptal ViV-TMVR.

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Section: Clinical Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A step-by-step guide to transseptal valve-in-valve transcatheter mitral valve replacement

Harloff¹,

Chowdhury²,

Hirji³

et al. 2021

Ann Cardiothorac Surg

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“…The Caisson TMVR System, just as Sapien M3 and CardiaQ valves, is delivered via transfemoral approach. The valve design includes two separate components: a stent (anchor) and the valve (28). The anchor is a D-shaped, self-expanding nitinol structure, which is implanted at the level of the native mitral annulus, and it is the backbone for the bioprosthesis ( Table 2).…”

Section: Caisson Tmvr Systemmentioning

confidence: 99%

Current Devices in Mitral Valve Replacement and Their Potential Complications

Gheorghe

Brouwer

Wang

et al. 2020

Front. Cardiovasc. Med.

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Mitral regurgitation is one of the most prevalent valvulopathies worldwide, and its surgical treatment is not feasible in all cases. The elderly and frail with several comorbidities and left ventricular dysfunction are often managed conservatively. Percutaneous treatment (repair or replacement) of the mitral valve has emerged as a potential option for those patients who are at a high risk for surgery. Mitral valve repair with the Mitraclip device proved both increased safety and mortality reduction in patients with severe mitral regurgitation. On the other hand, in the last decade, percutaneous mitral replacement opened new frontiers in the field of cardiac structural interventions. There are few mitral devices; some are in the early phase of development and some are waiting for CE mark of approval. The evolution of these devices was more complicated compared to the aortic technology due to the native mitral valve's complexity and access. This review aims to provide an overview of the current devices, their specific features, and their potential complications.

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“…T ranscatheter Mitral Valve-in-Valve Implantation (TMViVI) has recently emerged as a novel therapy for degenerated mitral valve bioprosthesis. [1] Reoperative sternotomy for mitral valve surgery is associated with a substantial risk of mortality and morbidity. Additionally, the patients who undergo re-operative mitral valve replacement are older and more fragile.…”

Section: Introductionmentioning

confidence: 99%

The Trans-Septal Approach In Transcatheter Mitral Valve-In-Valve Implantation For Degenerative Bioprosthesis

Otaiby¹,

Garni²,

Alkhushail³

et al. 2020

Journal of the Saudi Heart Association

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Background: Transcatheter Mitral Valve-in-Valve Implantation (TMViVI) has recently emerged as a novel therapy for degenerated mitral valve bioprosthesis. Re-operative mitral valve surgery is associated with a substantial risk of mortality and morbidity. The objective of this study was to describe the outcomes of transcatheter mitral valve-in-valve implantations in our cardiac center. Methods: Twenty-two patients underwent the valve-in-valve procedure because of bioprosthesis degeneration from March 2017 to October 2018. Clinical, echocardiographic, procedural details and survival at follow up were assessed. Results: Eight patients refused re-operative cardiac surgery while others were deemed a high risk for conventional reoperative sternotomy. All patients had TMViVI performed via a trans-septal approach, and the prosthesis was implanted successfully with immediate hemodynamic improvement in 20 patients. One patient had tamponade (4.55%), two had permanent pacemaker insertion (9.09%), two patients had a renal impairment (9.09%), and three patients had vascular complications (13.64%). There was one aborted procedure for the failure to cross the tissue valve with a transcatheter valve, and one patient was converted to an emergency mitral valve surgery. All patients were discharged in NYHA class I/II and NYHA class was markedly improved at one-year follow-up (p ¼ 0.002). Conclusions: Trans-septal mitral valve-in-valve implantation can be performed safely for degenerative mitral valve bioprosthesis and with favorable early clinical and hemodynamic outcomes.

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Transcatheter Mitral Valve Replacement in the Transcatheter Aortic Valve Replacement Era

Cited by 51 publications

References 58 publications

A step-by-step guide to transseptal valve-in-valve transcatheter mitral valve replacement

A step-by-step guide to transseptal valve-in-valve transcatheter mitral valve replacement

Current Devices in Mitral Valve Replacement and Their Potential Complications

The Trans-Septal Approach In Transcatheter Mitral Valve-In-Valve Implantation For Degenerative Bioprosthesis

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