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Sengupta A, Alexis SL, Sun E, Ho E, Latib A, Tang GH. Transcatheter Mitral Valve Replacement. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch64.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Sengupta A, Yazdchi F, Alexis SL, Percy E, Premkumar A, Hirji S, Bapat VN, Bhatt DL, Kaneko T, Tang GHL. Reoperative Mitral Surgery Versus Transcatheter Mitral Valve Replacement: A Systematic Review. J Am Heart Assoc 2021; 10:e019854. [PMID: 33686870 PMCID: PMC8174229 DOI: 10.1161/jaha.120.019854] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bioprosthetic mitral structural valve degeneration and failed mitral valve repair (MVr) have traditionally been treated with reoperative mitral valve surgery. Transcatheter mitral valve-in-valve (MVIV) and valve-in-ring (MVIR) replacement are now feasible, but data comparing these approaches are lacking. We sought to compare the outcomes of (1) reoperative mitral valve replacement (redo-MVR) and MVIV for structural valve degeneration, and (2) reoperative mitral valve repair (redo-MVr) or MVR and MVIR for failed MVr. A literature search of PubMed, Embase, and the Cochrane Library was conducted up to July 31, 2020. Thirty-two studies involving 25 832 patients were included. Redo-MVR was required in ≈35% of patients after index surgery at 10 years, with 5% to 15% 30-day mortality. MVIV resulted in >95% procedural success with 30-day and 1-year mortality of 0% to 8% and 11% to 16%, respectively. Recognized complications included left ventricular outflow tract obstruction (0%-6%), valve migration (0%-9%), and residual regurgitation (0%-6%). Comparisons of redo-MVR and MVIV showed no statistically significant differences in mortality (11.3% versus 11.9% at 1 year, P=0.92), albeit higher rates of major bleeding and arrhythmias with redo-MVR. MVIR resulted in 0% to 34% mortality at 1 year, whereas both redo-MVr and MVR for failed repairs were performed with minimal mortality and durable long-term results. MVIV is therefore a viable alternative to redo-MVR for structural valve degeneration, whereas redo-MVr or redo-MVR is preferred for failed MVr given the suboptimal results with MVIR. However, not all patients will be candidates for MVIV/MVIR because anatomical restrictions may preclude transcatheter options from adequately addressing the underlying pathology.
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Affiliation(s)
- Aditya Sengupta
- Department of Cardiovascular Surgery Mount Sinai Hospital New York NY
| | - Farhang Yazdchi
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | - Sophia L Alexis
- Department of Cardiovascular Surgery Mount Sinai Hospital New York NY
| | - Edward Percy
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | - Akash Premkumar
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | - Sameer Hirji
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | | | - Deepak L Bhatt
- Brigham and Women's Heart & Vascular CenterHarvard Medical School Boston MA
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery Brigham and Women's Hospital Boston MA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery Mount Sinai Hospital New York NY
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Schaefer A, Seiffert M, Blankenberg S, Conradi L. Transapical mitral valve-in-ring procedure with a novel self-expandable transcatheter heart valve: first- and last-in-man report. Eur J Cardiothorac Surg 2020; 58:190-192. [PMID: 31860025 DOI: 10.1093/ejcts/ezz350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/14/2019] [Accepted: 11/20/2019] [Indexed: 11/14/2022] Open
Abstract
Interventional therapy of failing surgical mitral valve replacement and repair is an appealing option in patients who are not eligible for redo surgery. We herein report on the first-in-human use of a repositionable, self-expandable transcatheter heart valve with motorized delivery for a transapical mitral valve-in-ring procedure. After implantation, fluoroscopy showed no residual regurgitation and pressure measurements did not reveal any signs of left ventricular outflow tract obstruction.
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Affiliation(s)
- Andreas Schaefer
- Departments of Cardiovascular Surgery and General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Moritz Seiffert
- Departments of Cardiovascular Surgery and General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Departments of Cardiovascular Surgery and General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Departments of Cardiovascular Surgery and General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Mitral valve regurgitation: a disease with a wide spectrum of therapeutic options. Nat Rev Cardiol 2020; 17:807-827. [DOI: 10.1038/s41569-020-0395-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 12/30/2022]
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Beg F, Dadu RT, Reardon MJ, Little SH, Kleiman NS, Barker CM. Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve. Methodist Debakey Cardiovasc J 2019; 15:149-151. [PMID: 31384379 DOI: 10.14797/mdcj-15-2-149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patients with advanced valvular disease may be at high or prohibitive risk for surgical management. We describe a patient with previous mitral and tricuspid valve repair and recurrent admissions for New York Heart Association Class IV heart failure symptoms due to severe mitral stenosis and severe tricuspid regurgitation. Due to her comorbidities and two previous sternotomies, the patient was at high risk for surgery. We performed a simultaneous transfemoral mitral and tricuspid valve-in-ring implantation. This is the first report of its kind using a Sapien 3 valve (Edwards Lifesciences).
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Affiliation(s)
- Faheemullah Beg
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Razvan T Dadu
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Michael J Reardon
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Stephen H Little
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Neal S Kleiman
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Colin M Barker
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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Cheung A, Denti P, Kiaii B, Bagur R, Webb J, Latib A, Alfieri O. Mitral Valve-in-Ring Implantation With a Dedicated Transcatheter Mitral Valve Replacement System. JACC Cardiovasc Interv 2019; 10:2012-2014. [PMID: 28982565 DOI: 10.1016/j.jcin.2017.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/01/2017] [Indexed: 10/18/2022]
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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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Urena M, Brochet E, Lecomte M, Kerneis C, Carrasco JL, Ghodbane W, Abtan J, Alkhoder S, Raffoul R, Iung B, Nataf P, Vahanian A, Himbert D. Clinical and haemodynamic outcomes of balloon-expandable transcatheter mitral valve implantation: a 7-year experience. Eur Heart J 2018; 39:2679-2689. [DOI: 10.1093/eurheartj/ehy271] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 04/24/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Marina Urena
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
| | - Eric Brochet
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
| | - Milena Lecomte
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
| | - Caroline Kerneis
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
| | - Jose Luis Carrasco
- Department of Anesthesiology, Bichat Claude Bernard Hospital-Paris VII University, 46 rue Henri Huchard, Paris, France
| | - Walid Ghodbane
- Department of Cardiac Surgery, Bichat Claude Bernard Hospital-Paris VII University, 46 rue Henri Huchard, Paris, France
| | - Jérémie Abtan
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
| | - Soleiman Alkhoder
- Department of Cardiac Surgery, Bichat Claude Bernard Hospital-Paris VII University, 46 rue Henri Huchard, Paris, France
| | - Richard Raffoul
- Department of Cardiac Surgery, Bichat Claude Bernard Hospital-Paris VII University, 46 rue Henri Huchard, Paris, France
| | - Bernard Iung
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
| | - Patrick Nataf
- Department of Cardiac Surgery, Bichat Claude Bernard Hospital-Paris VII University, 46 rue Henri Huchard, Paris, France
| | - Alec Vahanian
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
| | - Dominique Himbert
- Department of Cardiology, Bichat Claude Bernard Hospital-Paris VII University, 46 Henri Huchard, Paris, France
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Affiliation(s)
- Vinayak Bapat
- Department of Cardiothoracic Surgery, Guy's and St. Thomas' Hospital, London, United Kingdom
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Duerr GD, Sinning JM, Mellert F. New expandable mitral annuloplasty ring facilitates transcatheter mitral valve implantation: proof of concept. EUROINTERVENTION 2016; 11:e1662-8. [PMID: 27056127 DOI: 10.4244/eijv11i14a318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Transcatheter mitral valve-in-ring (TMVIR) implantation with transcatheter heart valve (THV) prostheses can be performed in patients with recurrent mitral regurgitation (MR) following annuloplasty. However, an oval configuration and sometimes the rigidity of surgical rings can often lead to suboptimal THV expansion, resulting in considerable paravalvular or central leakage. Therefore, our aim was to develop an annuloplasty ring that fully adjusts to THV implantation. METHODS AND RESULTS A three-dimensional annuloplasty ring was separated into four pieces at defined locations, the sections were reconnected with heat-shrinkable tubing and rearranged into the original shape. A non-tear stainless steel circular cord of defined length was inserted into the ring's sewing cuff to serve as a limiting structure for THV expansion. We implanted this ring in the mitral position into an isolated pig heart, deployed a THV into the ring, and investigated its function. Fluoroscopy showed that, upon THV deployment, the four breaking points of the ring separated as expected, and the ring expanded in a circular fashion to full expansion of the limiting cord. It securely anchored the THV to the ring, leaving no paravalvular gaps. CONCLUSIONS We developed an expandable mitral ring to which the THV attached without leakage. This may impact on the future design of annuloplasty rings. Further studies should evaluate the safety of increasing the perimeter of a mitral ring and its durability.
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Affiliation(s)
- Georg D Duerr
- Department of Cardiac Surgery, University Heart Center Bonn, Bonn, Germany
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Chiam PTL, Ewe SH. The expanding indications of transcatheter aortic valve implantation. Future Cardiol 2016; 12:209-19. [PMID: 26916608 DOI: 10.2217/fca.15.86] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI), also known as transcatheter aortic valve replacement, is increasingly performed worldwide and is a technology that is here to stay. It has become the treatment of choice for inoperable patients and an alternative option for patients at high surgical risk with severe aortic stenosis. Early results of TAVI in intermediate-risk patients appear promising although larger randomized trial results are awaited before the widespread adoption of this technology in this big pool of patients. In patients with bicuspid aortic stenosis and degenerated surgical bioprostheses, TAVI has been shown to be feasible and relatively safe, though certain important considerations remain. Indications for TAVI are likely to grow as newer generation and improved devices and delivery systems become available.
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Affiliation(s)
- Paul T L Chiam
- The Heart & Vascular Centre, Mount Elizabeth Hospital, 3 Mount Elizabeth, 228510, Singapore.,National University of Singapore, Yong Loo Lin School of Medicine, 1E Kent Ridge Rd 119228, NUHS Tower Block, Level 11, 117597, Singapore
| | - See Hooi Ewe
- Department of Cardiology, National Heart Centre, 5 Hospital Dr, 169609, Singapore
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Abstract
Mitral valve (MV) disease is one of the most common heart valve diseases. The surgical and interventional treatment for MV disease requires a multidisciplinary approach. For primary mitral valve regurgitation (MVR) surgical MV repair is the treatment of choice, which can be performed with an excellent outcome and long-term survival in reference centers. The surgical technique used for MV repair depends on the pathological mechanism, the morphological dimensions of the MV, the operative risk and the expertise of the cardiac surgeon. The surgical and interventional treatment of secondary MVVR is the subject of on-going discussions. In patients with moderate secondary MVR undergoing coronary artery bypass grafting, concomitant MV repair should be performed. In the presence of severe secondary MR with risk factors for failure of MV repair, patients should consider having MV replacement. In the rare cases of patients presenting with mitral valve stenosis (MVS) MV repair can be considered in young patients and who are most often treated with MV replacement. The choice between biological or mechanical MV replacement depends on the pathophysiology, the comorbidities, the amount of anticoagulation necessary and the age of the patient. New percutaneous techniques for MV replacement offer new treatment options for reoperation in high-risk patients.
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Praz F, Windecker S, Huber C, Carrel T, Wenaweser P. Expanding Indications of Transcatheter Heart Valve Interventions. JACC Cardiovasc Interv 2015; 8:1777-96. [DOI: 10.1016/j.jcin.2015.08.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/18/2015] [Accepted: 08/24/2015] [Indexed: 01/10/2023]
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