BACKGROUND: Transcatheter mitral valve-in-valve (TMVIV) procedure, either transapical (TA) or trans-septal (TS) has become a valuable alternative to conventional redo surgery in case of failing mitral bioprosthesis with good clinical outcomes. Here we present our fourteen-year institutional experience. METHODS: All consecutive patients treated with TMVIV with either TA or TS access at our centre between July 2007 and July 2020 were included. Periprocedural and 30-day follow-up (FU) results are reported and TA and TS data are compared. RESULTS: Eighty-two patients were included, of those 60 (73.2%) were TA while 22 (26.8%) were TS. Men represented 51.2% of the population with a mean age of 77.3±9.0 years. STS score and EuroSCORE II were 11.4%±6.2% and 11.5%±6.5% respectively. Baseline characteristics of TA and TS groups were comparable. TMVIV was performed at a median time of 9.3 years [interquartile range (IQR), 7.9-12.0 days] from the initial mitral valve surgery. Balloon expandable transcatheter heart valve (THV) prostheses (Edwards LifeSciences Corp., Irvine, CA, USA) were used exclusively. Technical success was 97.6% (96.7% and 100.0% for TA and TS respectively) with two (2.4%) periprocedural death, both in the TA group (P=0.533). We observed four (4.9%) left ventricular outflow tract (LVOT) obstructions with one being hemodynamically significant. Six (7.3%) major bleeding occurred in the TA group, not significantly different from TS group (P=0.279). The median length of stay was 6 days (IQR, 4-12 days, 1.5 vs. 7.0 days for TS and TA groups respectively, P=0.001). The overall 30-day mortality rate was 3.7%. We also observed three (3.7%) structural valve deteriorations and in one (1.2%) case the patient required redo mitral surgery at two months. Eighty-seven-point-eight percent of patients were I-II New York Heart Association (NYHA) class. At 30-day FU mean transmitral valve gradient was 7.3±2.7 mmHg and one patient (1.2%) had mitral regurgitation greater than mild. TA and TS groups were comparable. CONCLUSIONS: Our 14-year single-center experience with TMVIV confirms procedural safety and is an effective alternative to redo surgery with comparable results with both TA and TS. With device, technical improvements and increasing operators' experience, TS is the preferred option for TMVIV. However, in some highly selected patient, TA may still play an important role. 2021 Annals of Cardiothoracic Surgery. All rights reserved.
BACKGROUND: Transcatheter mitral valve-in-valve (TMVIV) procedure, either transapical (TA) or trans-septal (TS) has become a valuable alternative to conventional redo surgery in case of failing mitral bioprosthesis with good clinical outcomes. Here we present our fourteen-year institutional experience. METHODS: All consecutive patients treated with TMVIV with either TA or TS access at our centre between July 2007 and July 2020 were included. Periprocedural and 30-day follow-up (FU) results are reported and TA and TS data are compared. RESULTS: Eighty-two patients were included, of those 60 (73.2%) were TA while 22 (26.8%) were TS. Men represented 51.2% of the population with a mean age of 77.3±9.0 years. STS score and EuroSCORE II were 11.4%±6.2% and 11.5%±6.5% respectively. Baseline characteristics of TA and TS groups were comparable. TMVIV was performed at a median time of 9.3 years [interquartile range (IQR), 7.9-12.0 days] from the initial mitral valve surgery. Balloon expandable transcatheter heart valve (THV) prostheses (Edwards LifeSciences Corp., Irvine, CA, USA) were used exclusively. Technical success was 97.6% (96.7% and 100.0% for TA and TS respectively) with two (2.4%) periprocedural death, both in the TA group (P=0.533). We observed four (4.9%) left ventricular outflow tract (LVOT) obstructions with one being hemodynamically significant. Six (7.3%) major bleeding occurred in the TA group, not significantly different from TS group (P=0.279). The median length of stay was 6 days (IQR, 4-12 days, 1.5 vs. 7.0 days for TS and TA groups respectively, P=0.001). The overall 30-day mortality rate was 3.7%. We also observed three (3.7%) structural valve deteriorations and in one (1.2%) case the patient required redo mitral surgery at two months. Eighty-seven-point-eight percent of patients were I-II New York Heart Association (NYHA) class. At 30-day FU mean transmitral valve gradient was 7.3±2.7 mmHg and one patient (1.2%) had mitral regurgitation greater than mild. TA and TS groups were comparable. CONCLUSIONS: Our 14-year single-center experience with TMVIV confirms procedural safety and is an effective alternative to redo surgery with comparable results with both TA and TS. With device, technical improvements and increasing operators' experience, TS is the preferred option for TMVIV. However, in some highly selected patient, TA may still play an important role. 2021 Annals of Cardiothoracic Surgery. All rights reserved.
Authors: Ronen Gurvitch; Anson Cheung; Jian Ye; David A Wood; Alexander B Willson; Stefan Toggweiler; Ronald Binder; John G Webb Journal: J Am Coll Cardiol Date: 2011-11-15 Impact factor: 24.094
Authors: Philipp Blanke; Christopher Naoum; Danny Dvir; Vinayak Bapat; Kevin Ong; David Muller; Anson Cheung; Jian Ye; James K Min; Nicolo Piazza; Pascal Theriault-Lauzier; John Webb; Jonathon Leipsic Journal: JACC Cardiovasc Imaging Date: 2016-03-09
Authors: Sung-Han Yoon; Brian K Whisenant; Sabine Bleiziffer; Victoria Delgado; Abhijeet Dhoble; Niklas Schofer; Lena Eschenbach; Eric Bansal; Dale J Murdoch; Marco Ancona; Tobias Schmidt; Ermela Yzeiraj; Flavien Vincent; Hiroki Niikura; Won-Keun Kim; Masahiko Asami; Axel Unbehaun; Sameer Hirji; Buntaro Fujita; Miriam Silaschi; Gilbert H L Tang; Shingo Kuwata; S Chiu Wong; Antonio H Frangieh; Colin M Barker; James E Davies; Alexander Lauten; Florian Deuschl; Luis Nombela-Franco; Rajiv Rampat; Pedro Felipe Gomes Nicz; Jean-Bernard Masson; Harindra C Wijeysundera; Horst Sievert; Daniel J Blackman; Enrique Gutierrez-Ibanes; Daisuke Sugiyama; Tarun Chakravarty; David Hildick-Smith; Fabio Sandoli de Brito; Christoph Jensen; Christian Jung; Richard W Smalling; Martin Arnold; Simon Redwood; Albert Markus Kasel; Francesco Maisano; Hendrik Treede; Stephan M Ensminger; Saibal Kar; Tsuyoshi Kaneko; Thomas Pilgrim; Paul Sorajja; Eric Van Belle; Bernard D Prendergast; Vinayak Bapat; Thomas Modine; Joachim Schofer; Christian Frerker; Joerg Kempfert; Guilherme F Attizzani; Azeem Latib; Ulrich Schaefer; John G Webb; Jeroen J Bax; Raj R Makkar Journal: Eur Heart J Date: 2019-02-01 Impact factor: 29.983
Authors: Sung-Han Yoon; Brian K Whisenant; Sabine Bleiziffer; Victoria Delgado; Niklas Schofer; Lena Eschenbach; Buntaro Fujita; Rahul Sharma; Marco Ancona; Ermela Yzeiraj; Stefano Cannata; Colin Barker; James E Davies; Antonio H Frangieh; Florian Deuschl; Tomaz Podlesnikar; Masahiko Asami; Abhijeet Dhoble; Anthony Chyou; Jean-Bernard Masson; Harindra C Wijeysundera; Daniel J Blackman; Rajiv Rampat; Maurizio Taramasso; Enrique Gutierrez-Ibanes; Tarun Chakravarty; Guiherme F Attizzani; Tsuyoshi Kaneko; S Chiu Wong; Horst Sievert; Fabian Nietlispach; David Hildick-Smith; Luis Nombela-Franco; Lenard Conradi; Christian Hengstenberg; Michael J Reardon; Albert Markus Kasel; Simon Redwood; Antonio Colombo; Saibal Kar; Francesco Maisano; Stephan Windecker; Thomas Pilgrim; Stephan M Ensminger; Bernard D Prendergast; Joachim Schofer; Ulrich Schaefer; Jeroen J Bax; Azeem Latib; Raj R Makkar Journal: J Am Coll Cardiol Date: 2017-08-29 Impact factor: 24.094
Authors: Hunaid A Vohra; Robert N Whistance; Apostolos Roubelakis; Andrew Burton; Clifford W Barlow; Geoffrey M K Tsang; Steve A Livesey; Sunil K Ohri Journal: Interact Cardiovasc Thorac Surg Date: 2012-01-31
Authors: Hemal Gada; Ajay J Kirtane; Kaijun Wang; Yang Lei; Elizabeth Magnuson; Matthew R Reynolds; Mathew R Williams; Susheel Kodali; Torsten P Vahl; Suzanne V Arnold; Martin B Leon; Vinod Thourani; Wilson Y Szeto; David J Cohen Journal: Circ Cardiovasc Qual Outcomes Date: 2015-06-09
Authors: Sammy Elmariah; William F Fearon; Ignacio Inglessis; Gus J Vlahakes; Brian R Lindman; Maria C Alu; Aaron Crowley; Susheel Kodali; Martin B Leon; Lars Svensson; Philippe Pibarot; Rebecca T Hahn; Vinod H Thourani; Igor F Palacios; D Craig Miller; Pamela S Douglas; Jonathan J Passeri Journal: JACC Cardiovasc Interv Date: 2017-12-11 Impact factor: 11.195
Authors: Danny Dvir; John G Webb; Sabine Bleiziffer; Miralem Pasic; Ron Waksman; Susheel Kodali; Marco Barbanti; Azeem Latib; Ulrich Schaefer; Josep Rodés-Cabau; Hendrik Treede; Nicolo Piazza; David Hildick-Smith; Dominique Himbert; Thomas Walther; Christian Hengstenberg; Henrik Nissen; Raffi Bekeredjian; Patrizia Presbitero; Enrico Ferrari; Amit Segev; Arend de Weger; Stephan Windecker; Neil E Moat; Massimo Napodano; Manuel Wilbring; Alfredo G Cerillo; Stephen Brecker; Didier Tchetche; Thierry Lefèvre; Federico De Marco; Claudia Fiorina; Anna Sonia Petronio; Rui C Teles; Luca Testa; Jean-Claude Laborde; Martin B Leon; Ran Kornowski Journal: JAMA Date: 2014-07 Impact factor: 56.272