Title |
Transapical Transcatheter Valve-in-Valve Implantation for Failed Mitral Valve Bioprosthesis.
|
---|---|
Published in |
Israel Medical Association Journal, January 2016
|
Pubmed ID | |
Authors |
Eyal R Nachum, Ehud Raanani, Amit Segev, Victor Guetta, Ilan Hai, Amihai Shinfeld, Paul Fefer, Hamdan Ashraf, Israel Barabash, Amjad Shalabi, Dan Spiegelstein |
Abstract |
Background: The rate of mitral bioprosthesis implantation in clinical practice is increasing. Transcatheter valve-in- valve implantation has been described for high risk patients requiring redo valve surgery. To report our experience with transapical valve-in-valve implantation for failed mitral bioprosthesis. Since 2010, 10 patients have undergone transapical valve-in-valve implantation for failed bioprosthesis in our center. Aortic valve-in-valve implantation was performed in one of them and mitral valve-in-valve implantation in nine. Mean age was 82 ± 4 years and 6 were female (67%). Mean time from original mitral valve (MV) replacement to valve-in-valve procedure was 10.5 ± 3.7 years. Follow-up was completed by all patients with a mean duration of 13 ± 12 months. Preoperatively, all patients presented with significant mitral regurgitation, two with mitral stenosis due to structural valve failure. All nine patients underwent successful transapical valve-in-valve implantation with an Edwards Sapien balloon expandable valve. There was no in-hospital mortality. Mean and median hospital duration was 15 ± 18 and 7 days respectively. Valve implantation was successful in all patients and there were no major complications, except for major femoral access bleeding in one patient. At last follow-up, all patients were alive and in NYHA functional class I or II. Echocardiography follow-up demonstrated that mitral regurgitation was absent or trivial in seven patients and mild in two. At follow-up, peak and mean gradients changed from 26 ± 4 and 8 ± 2 at baseline to 16.7 ± 3 and 7.3 ± 1.5, respectively. Transcatheter transapical mitral valve-in-valve implantation for failed bioprosthesis is feasible in selected high risk patients. Our early experience with this strategy is encouraging. Larger randomized trials with long-term clinical and echocardiographic follow-up are recommended. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 25 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Bachelor | 5 | 20% |
Other | 3 | 12% |
Student > Postgraduate | 3 | 12% |
Researcher | 2 | 8% |
Student > Ph. D. Student | 2 | 8% |
Other | 3 | 12% |
Unknown | 7 | 28% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 13 | 52% |
Psychology | 1 | 4% |
Chemistry | 1 | 4% |
Physics and Astronomy | 1 | 4% |
Unknown | 9 | 36% |