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Dagher O, Santaló-Corcoy M, Perrin N, Dorval JF, Duggal N, Modine T, Ducharme A, Lamarche Y, Noly PE, Asgar A, Ben Ali W. Transcatheter valvular therapies in patients with left ventricular assist devices. Front Cardiovasc Med 2023; 10:1071805. [PMID: 36993995 PMCID: PMC10040555 DOI: 10.3389/fcvm.2023.1071805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/21/2023] [Indexed: 03/14/2023] Open
Abstract
Aortic, mitral and tricuspid valve regurgitation are commonly encountered in patients with continuous-flow left ventricular assist devices (CF-LVADs). These valvular heart conditions either develop prior to CF-LVAD implantation or are induced by the pump itself. They can all have significant detrimental effects on patients' survival and quality of life. With the improved durability of CF-LVADs and the overall rise in their volume of implants, an increasing number of patients will likely require a valvular heart intervention at some point during CF-LVAD therapy. However, these patients are often considered poor reoperative candidates. In this context, percutaneous approaches have emerged as an attractive "off-label" option for this patient population. Recent data show promising results, with high device success rates and rapid symptomatic improvements. However, the occurrence of distinct complications such as device migration, valve thrombosis or hemolysis remain of concern. In this review, we will present the pathophysiology of valvular heart disease in the setting of CF-LVAD support to help us understand the underlying rationale of these potential complications. We will then outline the current recommendations for the management of valvular heart disease in patients with CF-LVAD and discuss their limitations. Lastly, we will summarize the evidence related to transcatheter heart valve interventions in this patient population.
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Affiliation(s)
- Olina Dagher
- Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
- Departmentof Cardiac Sciences, Libin Cardiovascular Institute, Calgary, AB, Canada
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Marcel Santaló-Corcoy
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Nils Perrin
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
- Cardiology Division, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-François Dorval
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Neal Duggal
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI, United States
| | - Thomas Modine
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévêque, CHU Bordeaux, Bordeaux, France
| | - Anique Ducharme
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
| | - Yoan Lamarche
- Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
| | | | - Anita Asgar
- Department of Cardiology, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Walid Ben Ali
- Department of Surgery, Montreal Heart Institute, Montreal, QC, Canada
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
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Hu J, Chen Y, Cheng S, Zhang S, Wu K, Wang W, Zhou Y. Transcatheter mitral valve implantation for degenerated mitral bioprostheses or failed surgical annuloplasty rings: A systematic review and meta-analysis. J Card Surg 2018; 33:508-519. [PMID: 29989214 PMCID: PMC6175121 DOI: 10.1111/jocs.13767] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Transcatheter 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. METHODS A systematic literature review was conducted to summarize the data regarding the baseline characteristics and clinical outcomes of patients undergoing TMVIV and TMVIR procedures. RESULTS A 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. CONCLUSIONS TMVIV 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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Affiliation(s)
- Junjie Hu
- Department of Thoracic‐Cardiovascular SurgeryTongji HospitalTongji University School of MedicineShanghaiChina
| | - Yan Chen
- Department of Thoracic‐Cardiovascular SurgeryTongji HospitalTongji University School of MedicineShanghaiChina
| | - Sijin Cheng
- Department of Thoracic‐Cardiovascular SurgeryTongji HospitalTongji University School of MedicineShanghaiChina
| | - San Zhang
- Department of Thoracic‐Cardiovascular SurgeryTongji HospitalTongji University School of MedicineShanghaiChina
| | - Kaiqin Wu
- Department of Thoracic‐Cardiovascular SurgeryTongji HospitalTongji University School of MedicineShanghaiChina
| | - Wenli Wang
- Department of Thoracic‐Cardiovascular SurgeryTongji HospitalTongji University School of MedicineShanghaiChina
| | - Yongxin Zhou
- Department of Thoracic‐Cardiovascular SurgeryTongji HospitalTongji University School of MedicineShanghaiChina
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