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Alizadehasl A, Eslami S, Vakili K, Abdi S, Firouzi A, Azarfarin R, Abdi A. A challenging transseptal mitral valve in valve case report: Success and safety. Clin Case Rep 2024; 12:e8096. [PMID: 38292226 PMCID: PMC10825811 DOI: 10.1002/ccr3.8096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 09/16/2023] [Accepted: 09/27/2023] [Indexed: 02/01/2024] Open
Abstract
Key Clinical Message Transcatheter mitral valve implantation (TMVI) is considered a less-invasive approach than open-heart surgery, favored in high-risk patients elected for valve replacement. Although seemingly suitable, this procedure is highly operator-dependent. Abstract Transcatheter mitral valve implantation (TMVI) is an alternative in high-risk patients. We reported a 72-year-old patient with mitral bioprosthesis degeneration successfully receiving TMVI. The procedure has lower morbidity and mortality rate than the surgical approach but can be accompanied by several complications, especially when conducted by an inexperienced operator.
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Affiliation(s)
- Azin Alizadehasl
- Cardio‐Oncology Department and Research CenterRajaie Cardiovascular Medical & Research Center, Iran University of Medical ScienceTehranIran
| | - Samira Eslami
- Department of Adult EchocardiographyRajaie Cardiovascular Medical and Research CenterTehranIran
| | - Kimia Vakili
- Student Research Committee, Faculty of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Seifollah Abdi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical SciencesTehranIran
| | - Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical SciencesTehranIran
| | - Rasoul Azarfarin
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical SciencesTehranIran
| | - Amir Abdi
- Student Research Committee, School of Medicine, Tehran Medical SciencesIslamic Azad UniversityTehranIran
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Knox A, Bennetts JS, Gimpel D, Newland RF, Baker RA, Joseph MX, Rice GD, Kangaharan N, Sinhal A. Transcatheter mitral valve-in-valve: treatment of rheumatic heart disease in young patients. ANZ J Surg 2022; 92:3298-3303. [PMID: 36200709 DOI: 10.1111/ans.18076] [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: 03/11/2022] [Revised: 06/28/2022] [Accepted: 09/13/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Rheumatic heart disease (RHD) in young people presents a complex management problem. In Australia a significant proportion of those affected are Aboriginal and Torres Strait Islanders. Transcatheter mitral valve-in-valve (TMViV) replacement has emerged as an alternative to redo surgery in high-risk patients with degenerated mitral bioprostheses. The aim of this study is to review outcomes of TMViV replacement in young patients with RHD. METHODS A single-centre, retrospective review of prospectively collected data on patients undergoing TMViV from December 2017 to June 2021. Primary outcome was major adverse cardiovascular events. Secondary outcome was post-operative trans-thoracic echocardiogram (TTE) results. RESULTS There were seven patients with a mean age of 33 years and predominantly female (n = 5). Pre-operative comorbidities included diabetes (29%), chronic obstructive pulmonary disease (43%), left ventricular dysfunction (43%) and current smoking status (80%). Post-operative median length of hospital stay was 4 days with no post-operative renal failure, stroke, return to theatre, valve embolization or in hospital mortality. Post-operative TTE showed either nil or trivial central mitral regurgitation, no paravalvular leak and a median gradient of 5 mmHg (IQR 4.5, 7) across the new bioprosthesis; sustained at median follow-up of 22 months. CONCLUSION Current literature of TMViV replacement is focused on an older population with concurrent comorbidities. This study provides a unique insight into TMViV replacement in a young cohort of patients with complex social and geographical factors which sometimes prohibits the use of a mechanical valve. The prevalence of RHD remains high for Aboriginal and Torres Strait Islanders, planning for future repeat valve operations should be considered from the outset. We consider TMViV as a part of a staged procedural journey for young patients with RHD.
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Affiliation(s)
- Abbey Knox
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Jayme S Bennetts
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.,Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Damian Gimpel
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Richard F Newland
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.,Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Robert A Baker
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia.,Cardiothoracic Surgery, Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Majo X Joseph
- Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Gregory D Rice
- Cardiothoracic Surgery, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nadarajah Kangaharan
- Cardiology and Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Ajay Sinhal
- Department of Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia
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3
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Mao Y, Liu Y, Ma Y, Jin P, Li L, Yang J. Mitral Valve-in-Valve Implant of a Balloon-Expandable Valve Guided by 3-Dimensional Printing. Front Cardiovasc Med 2022; 9:894160. [PMID: 35711355 PMCID: PMC9195497 DOI: 10.3389/fcvm.2022.894160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022] Open
Abstract
Background Our goal was to explore the role of 3-dimensional (3D) printing in facilitating the outcome of a mitral valve-in-valve (V-in-V) implant of a balloon-expandable valve. Methods From November 2020 to April 2021, 6 patients with degenerated mitral valves were treated by a transcatheter mitral V-in-V implant of a balloon-expandable valve. 3D printed mitral valve pre- and post-procedure models were prepared to facilitate the process by making individualized plans and evaluating the outcomes. Results Each of the 6 patients was successfully implanted with a balloon-expandable valve. From post-procedural images and the 3D printed models, we could clearly observe the valve at the ideal position, with the proper shape and no regurgitation. 3D printed mitral valve models contributed to precise decisions, the avoidance of complications, and the valuation of outcomes. Conclusions 3D printing plays an important role in guiding the transcatheter mitral V-in-V implant of a balloon-expandable valve. Clinical Trial Registration ClinicalTrials.gov Protocol Registration System (NCT02917980).
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Affiliation(s)
- Yu Mao
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yang Liu
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yanyan Ma
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ping Jin
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lanlan Li
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Johnson MZ, Damianopoulos NJ, Lee F, Yong G. Mitral valve-in-valve implantation during pregnancy. BMJ Case Rep 2021; 14:e244270. [PMID: 34815226 PMCID: PMC8611431 DOI: 10.1136/bcr-2021-244270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/03/2022] Open
Abstract
A 32-year-old, 11-week pregnant African woman with known rheumatic heart disease presented to the emergency department with worsening shortness of breath on exertion. She had undergone a double bioprosthetic valve replacement and left atrial appendage resection 8 years prior for severe mitral stenosis, moderate mitral regurgitation and moderate aortic regurgitation. A transo-oesophageal echocardiography at this presentation confirmed a morphologically calcified and stenosed mitral bioprosthesis, with moderate stenosis of her aortic bioprosthesis. Her multidisciplinary team, including cardiologists, cardiothoracic surgeons and obstetricians, came to a consensus decision to proceed with a transseptal transcatheter valve implantation within the mitral valve prosthesis (valve-in-valve implantation). Transthoracic echocardiography performed 2 months post procedure showed satisfactory mitral valve gradients and at 30 weeks' gestation, she successfully delivered her fifth child. 2 years later, the valve in valve complex is still functioning well.
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Affiliation(s)
- Mark Zachary Johnson
- Anaesthetics, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Nicholas James Damianopoulos
- Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Felicity Lee
- Cardiology Dapartment, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Gerald Yong
- Cardiology Dapartment, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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5
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Perrin N, Müller H, Noble S. Transseptal mitral valve-in-valve implantation in a degenerated mitral bioprosthesis: A case report and literature review. Clin Case Rep 2021; 9:e04251. [PMID: 34194780 PMCID: PMC8223684 DOI: 10.1002/ccr3.4251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022] Open
Abstract
Transseptal TMViV should be considered for mitral bioprosthesis failure especially when large THV can be implanted. Elevated residual mean gradient and its effect on valve durability and potential valve thrombosis remains an unanswered question.
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Affiliation(s)
- Nils Perrin
- Department of MedicineCardiology DivisionStructural Heart UnitUniversity Hospitals of GenevaGenevaSwitzerland
| | - Hajo Müller
- Department of MedicineCardiology DivisionStructural Heart UnitUniversity Hospitals of GenevaGenevaSwitzerland
| | - Stephane Noble
- Department of MedicineCardiology DivisionStructural Heart UnitUniversity Hospitals of GenevaGenevaSwitzerland
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Otaiby MA, Al Garni TA, Alkhushail A, Almoghairi A, Samargandy S, Albabtain M, Algarni KD, Arafat AA, Khairallah H, Alamri H. The trans-septal approach in transcatheter mitral valve-in-valve implantation for degenerative bioprosthesis. J Saudi Heart Assoc 2020; 32:141-148. [PMID: 33154908 PMCID: PMC7640552 DOI: 10.37616/2212-5043.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/04/2020] [Accepted: 01/17/2020] [Indexed: 11/24/2022] Open
Abstract
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 re-operative 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 = 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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Affiliation(s)
- Mohammed Al Otaiby
- Adult Interventional Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Turki A Al Garni
- Adult Interventional Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdullah Alkhushail
- Adult Interventional Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdulrahman Almoghairi
- Adult Interventional Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Sondos Samargandy
- Adult Interventional Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Monirah Albabtain
- Cardiology Clinical Pharmacy Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Khaled D Algarni
- Cardiac Science Department, King Saud University, Riyadh, Saudi Arabia.,Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Amr A Arafat
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.,Cardiothoracic Surgery Department, Tanta University, Egypt
| | - Hatim Khairallah
- Adult Interventional Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Hussein Alamri
- Cardiothoracic Surgery Department, Tanta University, Egypt
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Fatehi Hassanabad A, Turcotte M, Dennehy C, Kim A, Malaisrie SC, Kent WDT. Contemporary Reoperative Mitral Valve Surgery: Technical Considerations and Clinical Outcomes. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:425-439. [DOI: 10.1177/1556984520949955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As patients with cardiac disease live longer, reoperative mitral valve surgery has become more common. Although these operations are technically challenging and of high risk, outcomes continue to improve. Minimally invasive techniques, better cardioprotective strategies, and advanced perioperative care have contributed to this. In this review, we discuss surgical approaches, intraoperative strategies, novel catheter-directed devices, and clinical outcomes of contemporary reoperative mitral valve surgery.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, AB, Canada
| | | | | | - Angela Kim
- Faculty of Medicine, University of Calgary, AB, Canada
| | - S. Chris Malaisrie
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - William D. T. Kent
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, AB, Canada
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