Turk Kardiyol Dern Ars. 2021; 49(1): 22-28 | DOI: 10.5543/tkda.2020.07893
Transcatheter mitral valve-in-valve implantation for failed bioprosthesis
Tahir I Mohamed1
, Abdulaziz A. Binzaid1
, Ali Almasood1
, Omar J. Baqal2
, Ziad Dahdouh1
, Karim Belhaj2
, Hussameddin T. Alhennawi.2
, Jehad A. Al Buraiki1
, Hani S. Al-sergani11
Department of Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia2
Department of Cardiology, Alfaisal University College of Medicine, Riyadh, Saudi Arabia
OBJECTIVE This study is a report of clinical and echocardiographic outcomes of experience with transapical mitral valve-in-valve (VIV) replacement.
METHODS Eleven patients with a mean age of 63.7±13.0 years who underwent transapical mitral VIV implantation for a failed bioprosthesis at a single institution were enrolled. All of the patients were considered high-risk for surgical intervention, with a Society of Thoracic Surgery predicted risk of mortality of 14.2±17.6%, and a mean European System for Cardiac Operative Risk Evaluation (EuroSCORE II) of 10.5±6.1%.
RESULTS Transapical mitral VIV implantation was successful in all of the patients. Edwards, Sapien XT and Sapien 3 valves (Edwards Lifesciences Corp., Irvine, CA, USA) were used in 8 (73%), 2 (18%), and 1 (9%) patients, respectively. Size 26 valves were used in 6 (55%) patients while size 29 valves were used in 5 (45%) patients. All of the patients (11, 100%) had no or only trace mitral regurgitation at the end of the procedure. The mean length of hospital stay was 19±8.0 days. The survival was 100% at 14 days, and 90% at 30 days and at 4 years. One patient died as a result of multiorgan failure on day 16 of intensive care unit stay. The mean mitral valve gradient across the percutaneous valve was 2.26±1.047 mmHg, and the mean valve area was 2.20±0.14 cm2. Through the 4 years follow up, the New York Heart Association class of the 10 patients remaining improved to class II with no readmission for heart failure. All of the patients were on coumadin with a target international normalized ratio of 23.
CONCLUSION In high-risk patients, transapical mitral VIV implantation can be performed with a high success rate and considerable improvement in clinical status.
Mitral, outcome; transapical; valve-in-valve; valve surgery.
How to cite this article
Tahir I Mohamed, Abdulaziz A. Binzaid, Ali Almasood, Omar J. Baqal, Ziad Dahdouh, Karim Belhaj, Hussameddin T. Alhennawi., Jehad A. Al Buraiki, Hani S. Al-sergani. Transcatheter mitral valve-in-valve implantation for failed bioprosthesis. Turk Kardiyol Dern Ars. 2021; 49(1): 22-28
Corresponding Author: Tahir I Mohamed, Saudi Arabia