Hyde M Russell1, Mayra E Guerrero2, Michael H Salinger3, Melissa A Manzuk4, Amit K Pursnani5, Dee Wang6, Hassan Nemeh6, Rahul Sakhuja7, Serguei Melnitchouk8, Ashish Pershad9, H Kenith Fang9, Sameh M Said10, James Kauten11, Gilbert H L Tang12, Gabriel Aldea13, Ted E Feldman5, Vinnie N Bapat14, Isaac M George14. 1. Division of Cardiovascular Surgery, NorthShore University HealthSystem, Evanston, Illinois. Electronic address: hrussell@northshore.org. 2. Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota. 3. Division of Cardiology and Cardiovascular Surgery, Froedtert/Medical College of Wisconsin, Milwaukee, Wisconsin. 4. Division of Cardiovascular Surgery, NorthShore University HealthSystem, Evanston, Illinois. 5. Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois. 6. Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan. 7. Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts. 8. Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts. 9. Banner-University Medicine Heart Institute, Phoenix, Arizona. 10. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota. 11. Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia. 12. Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York. 13. Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington. 14. Division of Vascular, Thoracic and Cardiac Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York.
Abstract
BACKGROUND: Mitral valve replacement in the setting of severe mitral annular calcification remains a surgical challenge. Transcatheter mitral valve replacement (TMVR) using an aortic balloon-expandable transcatheter heart valve is emerging as a potential treatment option for high surgical risk patients. Transseptal, transapical, or transatrial access is not always feasible, so an understanding of alternative implantation techniques is important. OBJECTIVES: The authors sought to present a step-by-step description of a contemporary transatrial TMVR technique using balloon-expandable aortic transcatheter heart valves. This procedure has evolved over time to address valve migration, left ventricular outflow tract obstruction, and paravalvular leak. The authors present a refined technique that has been associated with the most reproducible outcomes. METHODS: A step-by-step description of the TMVR technique and outcomes of 8 patients treated using this technique are described. Baseline patient clinical and echocardiographic characteristics and 30-day post-TMVR outcomes are presented. RESULTS: Eight patients underwent transatrial TMVR at a single institution. Five had previous cardiac surgery. Mean STS score was 8%. Technical success by MVARC (Mitral Valve Academic Research Consortium) criteria was 100%. There was zero in-hospital and 30-day mortality. Procedural success by MVARC criteria at 30 days was 100%. Paravalvular leak immediately post-implant was none or trace in 6 and mild in 1. CONCLUSIONS: The technique described is reproducible and was associated with favorable outcomes in this early experience. It represents a useful technique for the treatment of mitral valve disease in the setting of severe annular calcification. A structured and defined implantation technique is critical to investigators as this field evolves.
BACKGROUND: Mitral valve replacement in the setting of severe mitral annular calcification remains a surgical challenge. Transcatheter mitral valve replacement (TMVR) using an aortic balloon-expandable transcatheter heart valve is emerging as a potential treatment option for high surgical risk patients. Transseptal, transapical, or transatrial access is not always feasible, so an understanding of alternative implantation techniques is important. OBJECTIVES: The authors sought to present a step-by-step description of a contemporary transatrial TMVR technique using balloon-expandable aortic transcatheter heart valves. This procedure has evolved over time to address valve migration, left ventricular outflow tract obstruction, and paravalvular leak. The authors present a refined technique that has been associated with the most reproducible outcomes. METHODS: A step-by-step description of the TMVR technique and outcomes of 8 patients treated using this technique are described. Baseline patient clinical and echocardiographic characteristics and 30-day post-TMVR outcomes are presented. RESULTS: Eight patients underwent transatrial TMVR at a single institution. Five had previous cardiac surgery. Mean STS score was 8%. Technical success by MVARC (Mitral Valve Academic Research Consortium) criteria was 100%. There was zero in-hospital and 30-day mortality. Procedural success by MVARC criteria at 30 days was 100%. Paravalvular leak immediately post-implant was none or trace in 6 and mild in 1. CONCLUSIONS: The technique described is reproducible and was associated with favorable outcomes in this early experience. It represents a useful technique for the treatment of mitral valve disease in the setting of severe annular calcification. A structured and defined implantation technique is critical to investigators as this field evolves.
Authors: Luiz Rafael P Cavalcanti; Michel Pompeu B O Sá; Álvaro M Perazzo; Antonio C Escorel Neto; Rafael A F Gomes; Alexander Weymann; Konstantin Zhigalov; Arjang Ruhparwar; Ricardo C Lima Journal: Curr Atheroscler Rep Date: 2020-02-07 Impact factor: 5.113
Authors: Livia Gheorghe; Jorn Brouwer; Dee Dee Wang; Nina Wunderlich; Bushra Rana; Benno Rensing; Frank Eefting; Leo Timmers; Martin Swaans Journal: Front Cardiovasc Med Date: 2020-11-27