Megan Coylewright1, Allison K Cabalka2, Joseph A Malouf3, Jeffrey B Geske3, Peter M Pollak4, Rakesh M Suri5, Charanjit S Rihal6. 1. Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 2. Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, Minnesota. 3. Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota. 4. Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida. 5. Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota. 6. Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: rihal@mayo.edu.
Abstract
OBJECTIVES: The aim of this paper is to describe the feasibility of a novel transcatheter approach for mitral valve replacement using only venous access. BACKGROUND: Failure of mitral valve prostheses necessitating reoperation can represent a high-risk clinical scenario. Although repeat cardiac surgery remains the standard of care for most failed mitral valve operations, nascent transcatheter options are under development for patients at high or extremely risk of surgery. Most often, this is performed via a transapical approach in the operating room, with associated risk of complications as well as extended length of hospital stay. METHODS: We describe a case series of 4 consecutive patients at high risk of reoperation with degenerative mitral prostheses (bioprosthetic valves or rings) who successfully underwent transvenous, transseptal mitral valve replacement with a commercially available transcatheter heart valve. RESULTS: From April to May 2014, 4 consecutive patients underwent transvenous, transseptal mitral valve replacement with a transcatheter heart valve. The mean age was 72 ± 9.9 years, and the average Society of Thoracic Surgeons risk score was 12.5 ± 7.2%. All patients had severe, life-limiting dyspnea. The 4 procedures were successful without intra- or post-procedural complications; echocardiography indicated a well-seated and functioning mitral valve-in-valve or valve-in-ring. Patients were discharged within 2 days after valve replacement with marked improvement in dyspnea. CONCLUSIONS: We describe an innovative technique of transcatheter mitral valve replacement. This case series demonstrates the feasibility of transcatheter mitral valve replacement using only femoral venous access, with a marked reduction in complications and length of hospital stay compared with transapical access or redo surgery.
OBJECTIVES: The aim of this paper is to describe the feasibility of a novel transcatheter approach for mitral valve replacement using only venous access. BACKGROUND: Failure of mitral valve prostheses necessitating reoperation can represent a high-risk clinical scenario. Although repeat cardiac surgery remains the standard of care for most failed mitral valve operations, nascent transcatheter options are under development for patients at high or extremely risk of surgery. Most often, this is performed via a transapical approach in the operating room, with associated risk of complications as well as extended length of hospital stay. METHODS: We describe a case series of 4 consecutive patients at high risk of reoperation with degenerative mitral prostheses (bioprosthetic valves or rings) who successfully underwent transvenous, transseptal mitral valve replacement with a commercially available transcatheter heart valve. RESULTS: From April to May 2014, 4 consecutive patients underwent transvenous, transseptal mitral valve replacement with a transcatheter heart valve. The mean age was 72 ± 9.9 years, and the average Society of Thoracic Surgeons risk score was 12.5 ± 7.2%. All patients had severe, life-limiting dyspnea. The 4 procedures were successful without intra- or post-procedural complications; echocardiography indicated a well-seated and functioning mitral valve-in-valve or valve-in-ring. Patients were discharged within 2 days after valve replacement with marked improvement in dyspnea. CONCLUSIONS: We describe an innovative technique of transcatheter mitral valve replacement. This case series demonstrates the feasibility of transcatheter mitral valve replacement using only femoral venous access, with a marked reduction in complications and length of hospital stay compared with transapical access or redo surgery.
Authors: Tamer Owais; Mohammad El Garhy; Sebastian Elvinger; Eva Harmel; Tatiana Maria Sequeria Gross; Harald Lapp; Thomas Kuntze; Wolfgang Von Scheidt; Evaldas Girdauskas; Mahmoud Al-Jassem; Philipp Lauten Journal: Egypt Heart J Date: 2022-03-28
Authors: Pedro Felipe Gomes Nicz; Pedro Henrique M Craveiro de Melo; Pedro Henrique Ferro de Brito; Eliane Nogueira Lima; Ricardo Cavalcante E Silva; Maurício Lopes Prudente; Fernando Henrique Fernandes; Maurilio Onofre Deininger; Marcelo Antônio Cartaxo Queiroga Lopes; Fúlvio Soares Petrucci; Fernando Roquette Reis Filho; Marcos Antonio Marino; Rodrigo de Castro Bernardes; Eduardo Pessoa de Melo; Marco Antonio Praça Oliveira; José Armando Mangione; Fernanda Marinho Mangione; Carlos Henrique Eiras Falcão; Estêvão Carvalho de Campos Martins; Walter Lunardi; Fernando Bacal; Flávio Tarasoutchi; Fábio Sândoli de Brito Journal: Arq Bras Cardiol Date: 2020-09 Impact factor: 2.667