Paravalvular leak repair after balloon‐expandable transcatheter mitral valve implantation in mitral annular calcification: Early experience and lessons learned

2019 ◽  
Vol 94 (5) ◽  
pp. 764-772 ◽  
Author(s):  
Mohammed A. Al‐Hijji ◽  
Abdallah El Sabbagh ◽  
Mayra E. Guerrero ◽  
Charanjit S. Rihal ◽  
Mackram F. Eleid
Keyword(s):  
Mitral Valve ◽  
Early Experience ◽  
Lessons Learned ◽  
Paravalvular Leak ◽  
Mitral Annular Calcification ◽  
Valve Implantation ◽  
Annular Calcification

scholarly journals Current Devices in TMVI and Their Limitations: Focus on Tendyne

2020 ◽  
Vol 7 ◽  
Author(s):  
Gry Dahle
Keyword(s):  
United States ◽  
Mitral Valve ◽  
Treatment Options ◽  
Mitral Valve Regurgitation ◽  
Paravalvular Leak ◽  
Western World ◽  
Transcatheter Aortic Valve ◽  
High Incidence ◽  
Valve Implantation ◽  
Annular Calcification

Mitral valve regurgitation (MR) has a high incidence in the western world, and mortality is high for untreated severe MR. Catheter based repair was introduced with MitraClip in 2003, and some additional devices later came into the market. To expand the transcatheter treatment options for mitral valve disease, the first transcatheter mitral valve implantation (TMVI) was performed by Søndergaard et al. 2012, only 10 years after the first transcatheter aortic valve implantation (TAVI), however, the development has been much slower for the TMVI than for TAVI. From 2012, studies were started for several devices to prove feasibility and safety. However, there were big challenges in valve design; delivery systems and anchoring in addition to anatomical issues (avoid LVOT obstruction and paravalvular leak, big size of annulus). The main valves in studies were CardiaQ (later bought by Edwards Lifesciences, Irvine, United States), Tiara (Neovasc Inc., Richmond, Canada), Twelve (later Intrepid, Medtronic, MN, United States) and Tendyne™ (Abbott, MN, United States). I will focus on the Tendyne™ valve that is the only CE approved transcatheter mitral valve implant. It is available in a large number of sizes and is repositionable and retrievable. The results for the 100 first patients included in the early feasibility study (EFS) at 1 and 2 years are promising. Initially feasible for MR, but further investigations show promising results also for implant in mitral annular calcification.

scholarly journals Transcatheter Mitral Valve Implantation (TMVI) Using Edwards SAPIEN 3 Prostheses in Patients at Very High or Prohibitive Surgical Risk: A Single-Center Experience

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Nicolas Werner ◽  
Caroline Kilkowski ◽  
Dorothee Sutor ◽  
Udo Weisse ◽  
Steffen Schneider ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Nyha Class ◽  
Single Center ◽  
Mitral Annular Calcification ◽  
Surgical Risk ◽  
Transcatheter Heart Valve ◽  
Edwards Sapien ◽  
Sapien 3 ◽  
Valve Implantation ◽  
Annular Calcification

Background. Mitral valve surgery in patients with failing bioprosthesis, annuloplasty rings, or in patients with advanced mitral annular calcification (MAC) is associated with high morbidity and mortality rates. Percutaneous antegrade transseptal transcatheter mitral valve implantation (TMVI) has recently successfully been performed in those patients at high or prohibitive surgical risk, but data on patients treated by TMVI are sparse. This study sought to evaluate short- and midterm outcomes of patients treated by TMVI at our site in clinical practice. Methods and Results. From October 2016 to February 2018, seven patients (six women and one man) at high or prohibitive surgical risk underwent TMVI at our site. Three procedures were performed as TMVI in failed mitral valve bioprostheses (TMVI-VIV, “valve-in-valve”), one procedure was performed as TMVI in a failed mitral annuloplasty ring (TMVI-R), and three procedures were performed as TMVI in advanced native mitral annular calcification (TMVI-MAC). Mean age of the population treated was 77 ± 8.1 years, and mean log EuroScore I was 39 ± 0.12%. In all patients, an Edwards SAPIEN 3 transcatheter heart valve was implanted under 3D-TOE and fluoroscopic guidance using a transvenous/transseptal access. Indication for TMVI was the presence of advanced heart failure symptoms in all patients (NYHA class III/IV). The predominant dysfunction of the mitral valve treated was severe regurgitation in 72% (n = 5) and severe stenosis in 29% (n = 2) of all patients. TMVI was technically successful in all procedures. Clinical success with functional improvement of at least one NYHA class after procedure compared with before procedure was also achieved in all patients. Median NYHA class improved significantly from 4 before procedure to 2 after TMVI (p=0.008). Mitral valve regurgitation was reduced to trace or mild in all but one patient, who showed moderate MR after TMVI-MAC. No patient-prosthesis mismatch or LVOT obstruction occurred after TMVI. Two patients underwent interventional ASD closure during the in-hospital course due to a large and persisting atrial septal defect after transseptal access. One patient underwent pacemaker implantation due to complete AV-block after TMVI. One patient died in hospital 12 days after the procedure due to severe hospital-acquired pneumonia and sepsis. In-hospital mortality rate was 14% (1/7) in this high-risk population. After hospital discharge, no death occurred and clinical improvement—according to NYHA functional class—remained stable during one-year follow-up. Conclusion. In this small single-center series, TMVI appears promising for patients at high or prohibitive surgical risk with either failing mitral bioprostheses/annuloplasty rings or native mitral valve dysfunction in combination with advanced MAC. Gaining experience in TMVI and new valves will further improve safety and efficacy of this new treatment option.

scholarly journals Transapical transcatheter mitral valve implantation in mitral annular calcification: Role of fusion imaging

2020 ◽  
Vol 3 ◽  
pp. 146-149
Author(s):  
Amedeo Anselmi ◽  
Hervé Corbineau ◽  
Jean-Philippe Verhoye ◽  
Erwan Donal
Keyword(s):  
Mitral Valve ◽  
Fusion Imaging ◽  
Mitral Annular Calcification ◽  
Valve Implantation ◽  
Annular Calcification

scholarly journals Open-heart transseptal transcatheter mitral valve implantation with mitral annular calcification

2020 ◽  
Vol 22 (5) ◽  
pp. 207-209
Author(s):  
Shohei Morita ◽  
Shinya Takahashi ◽  
Mathieu Pernot ◽  
Lionel Leroux ◽  
Louis Labrousse
Keyword(s):  
Mitral Valve ◽  
Open Heart ◽  
Mitral Annular Calcification ◽  
Valve Implantation ◽  
Annular Calcification

scholarly journals Taming of the Tiger: A Novel Technique to Deal With Mitral Annular Calcification —A Case Series

2020 ◽  
Vol 23 (6) ◽  
pp. E793-E796
Author(s):  
Varghese Panicker ◽  
Renjith Sreekantan ◽  
Sai Suraj Kotera
Keyword(s):  
Mitral Valve ◽  
Case Reports ◽  
Treatment Options ◽  
Case Series ◽  
Mitral Valve Surgery ◽  
Paravalvular Leak ◽  
Valve Repair ◽  
Mitral Annular Calcification ◽  
Annular Reconstruction ◽  
Annular Calcification

Background: Mitral valve surgery can be challenging for patients with mitral annular calcification (MAC). The prevalence of MAC in patients who undergo mitral valve replacement is 19.9%. The  treatment options for MAC include complete decalcification and annular reconstruction with valve repair/replacement or performing a surgical valve repair or replacement without decalcification, accepting the risk of paravalvular leak. We describe three cases of mitral valve prolapse with posterior annular calcification, which were repaired using a unique technique that does not require decalcification. Case reports: The mitral annular calcification was heavy and involved most of the posterior annulus just sparing the commissures in all the three cases. Leaflet prolapse was dealt with by using neochordae, closing any clefts, and leaflet plication. Since the MAC ring was not complete and there was chance of further dilatation of the annulus, a partial annuloplasty was done using a PTFE felt (cut as strip). There was trivial to no mitral regurgitation with this technique in the immediate postoperative and five-year follow-up period echocardiography in all the three cases. Conclusion: This technique can benefit the major subset of pure mitral valve regurgitant lesions associated with MAC, which is limited to the posterior annulus.

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