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Chmielak Z, Dąbrowski M, Tyczyński P, Kukuła K, Michałowska I, Szudejko E, Skowroński J, Kuśmierczyk M, Witkowski A. Transcatheter aortic valve replacement in patients with previous mitral valve replacement. A systematic study. Postepy Kardiol Interwencyjnej 2020; 16:177-83. [PMID: 32636902 DOI: 10.5114/aic.2020.96061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/27/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Severe aortic stenosis (AS) is an ever-growing healthcare problem in ageing populations. Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of AS. However, TAVI in patients who have undergone mitral valve replacement (MVR) is associated with increased risk of mitral valve damage. Limited data exist on TAVI in patients with AS who underwent MVR in the past. Aim To retrospectively assess the clinical characteristics, detailed echocardiographic and computed tomography measurements, procedural and in-hospital outcome as well as any valve intervention or major adverse cardiovascular events according to VARC-2 criteria at follow-up of patients with a history of MVR, who underwent TAVI. Material and methods Seventeen patients with a history of mitral valve operation, in whom TAVI was performed between 2010 and 2018, were identified. Of these, 15 underwent previous MVR. Results Overall, TAVI resulted in a decrease of mean transaortic gradient by 38.3 ±14 mm Hg (p < 0.001) and a decrease of maximal transaortic gradient by 58.6 ±27.6 mm Hg (p < 0.001). A successful immediate result was obtained in 14 (93.3%) patients. One tamponade occurred during TAVI, which was successfully treated with pericardiocentesis. Post-procedurally, no significant changes in transmitral gradients or mitral regurgitations were observed. Two patients died after hospital discharge, one due to possible internal bleeding and the other due to infection. Conclusions TAVI in patients after MVR is feasible. Meticulous preinterventional echocardiographic and computed tomography planning is essential. Although recommended in previous reports, TEE guidance may not necessarily be obligatory during the procedure.
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Tanaka M, Yanagisawa R, Yashima F, Arai T, Jinzaki M, Shimizu H, Fukuda K, Watanabe Y, Naganuma T, Shirai S, Araki M, Tada N, Yamanaka F, Higashimori A, Takagi K, Ueno H, Tabata M, Mizutani K, Yamamoto M, Hayashida K; OCEAN-TAVI investigators. Previously implanted mitral surgical prosthesis in patients undergoing transcatheter aortic valve implantation: Procedural outcome and morphologic assessment using multidetector computed tomography. PLoS One 2019; 14:e0226512. [PMID: 31877159 DOI: 10.1371/journal.pone.0226512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/27/2019] [Indexed: 11/19/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) in the presence of a preexisting mitral prosthesis is challenging and its influence on the morphology of mitral prosthesis and the positioning of transcatheter heart valve (THV) is unknown. We assessed the feasibility of TAVI for patients with preexisting mitral prostheses, its influence on mitral prosthesis morphology, and the positional interaction between a newly implanted THV and mitral prosthesis using serial multidetector computed tomography (MDCT). Thirty-one patients with preexisting mitral prosthesis undergoing TAVI were included. MDCT was performed before and after TAVI. Thirty patients successfully underwent TAVI without interference from preexisting mitral prosthesis. Although opening disturbance of the mechanical mitral prosthesis by the THV edge was observed in 1 patient, the patient was managed conservatively. No THV embolization occurred. THV shift during deployment occurred in 9 patients and was predicted by a larger aortic annulus area (odds ratio: 1.24 per 10 mm2, 1.03–1.49, p = 0.02), possibly because of large THVs. The mitral mean pressure gradient was slightly higher after TAVI (3.7 vs. 4.3 mmHg, p = 0.002), whereas the mitral regurgitation grade was similar. MDCT showed that the size of the mitral prosthesis housing was unchanged after TAVI. The median distance between the mitral prosthesis and THV was 2.6 mm. The postprocedural angle between the mitral prosthesis and THV was larger than the preprocedural angle between the mitral prosthesis and the left ventricular outflow tract (64° vs. 61°, p = 0.03). Thus, TAVI is feasible in the case of preexisting mitral prosthesis. Serial MDCT demonstrated favorable THV positioning and unchanged mitral prosthesis morphology after TAVI.
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Thourani VH, Kelly JJ, Cervantes DG, Vemulapalli S, Manandhar P, Forcillo J, Holmes DR, Cohen DJ, Kirtane AJ, Kodali SK, Leon MB, Babaliaros V, Waksman R, Satler LF, Shults CC, Ben-Dor I, Rogers T, Kapadia S, Reardon MJ, Malaisrie SC, Gleason TG, Holper EM, Bavaria JE, Herrmann HC, Szeto WY, Carroll JD, Mack MJ. Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry. Ann Thorac Surg 2019; 109:1789-1796. [PMID: 31655043 DOI: 10.1016/j.athoracsur.2019.08.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 07/25/2019] [Accepted: 08/08/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Due to perceived technical challenges, patients with previous surgical mitral valve repair or replacement (SMVR) have been excluded from most transcatheter aortic valve replacement (TAVR) trials. Our objective was to compare the 30-day and 1-year outcomes of TAVR for patients with and without prior SMVR. METHODS In a retrospective review of The Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry, we compared 1097 patients with prior SMVR to 46,327 patients without prior SMVR who underwent TAVR between November 2011 and September 2015 at 394 US centers. Preoperative characteristics, procedural details, and clinical outcomes were analyzed. RESULTS Patients with previous SMVR were younger, more often female, and had higher STS predicted risk of mortality (8.6% vs 6.8%, P < .001). However, there was no difference in 30-day mortality (4.6% vs 5.5%, P = .293), myocardial infarction, stroke, reintervention, new dialysis, or readmission. Moderate/severe paravalvular leak at discharge was also similar (5.8% vs 4.9%, P = .343). At 1 year, morbidity was similar with slightly higher mortality among patients with prior SMVR (20% vs 17.5%, P = .087) that was significant after adjustment (hazard ratio 1.18, P = .043). The type of prior SMVR (repair, bioprosthetic replacement, or mechanical replacement) had no impact on 30-day or 1-year survival. CONCLUSIONS Patients with prior SMVR undergoing TAVR had similar 30-day outcomes, slightly higher 1-year mortality, and no increase in early paravalvular leak compared with patients who did not have previous SMVR. Prior SMVR should not preclude TAVR for appropriately selected patients.
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Affiliation(s)
- Vinod H Thourani
- Medstar Washington Hospital Center/Georgetown University, Washington, DC.
| | - John J Kelly
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | - David J Cohen
- Harvard Beth Israel Deaconess Hospital, Boston, Massachusetts
| | | | | | | | | | - Ron Waksman
- Medstar Washington Hospital Center/Georgetown University, Washington, DC
| | - Lowell F Satler
- Medstar Washington Hospital Center/Georgetown University, Washington, DC
| | - Christian C Shults
- Medstar Washington Hospital Center/Georgetown University, Washington, DC
| | - Itsik Ben-Dor
- Medstar Washington Hospital Center/Georgetown University, Washington, DC
| | - Toby Rogers
- Medstar Washington Hospital Center/Georgetown University, Washington, DC
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Vola M, Ruggieri VG, Campisi S, Grinberg D, Morel J, Favre JP, Ayari I, Issaz K, Fuzellier JF, Gerbay A. Sutureless 3f Enable valve implantation concomitant with mitral valve surgery. Interact Cardiovasc Thorac Surg 2015; 21:169-75. [DOI: 10.1093/icvts/ivv110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/02/2015] [Indexed: 11/14/2022] Open
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