Novel Transcatheter Mitral Valve Prosthesis for Patients With Severe Mitral Annular Calcification
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Novel Transcatheter Mitral Valve Prosthesis for Patients With Severe Mitral Annular Calcification. / Sorajja, Paul; Gössl, Mario; Babaliaros, Vasilis; Rizik, David; Conradi, Lenard; Bae, Richard; Burke, Robert F; Schäfer, Ulrich; Lisko, John C; Riley, Robert D; Guyton, Robert; Dumonteil, Nicolas; Berthoumieu, Pierre; Tchetche, Didier; Blanke, Philipp; Cavalcante, João L; Sun, Benjamin.
in: J AM COLL CARDIOL, Jahrgang 74, Nr. 11, 17.09.2019, S. 1431-1440.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Novel Transcatheter Mitral Valve Prosthesis for Patients With Severe Mitral Annular Calcification
AU - Sorajja, Paul
AU - Gössl, Mario
AU - Babaliaros, Vasilis
AU - Rizik, David
AU - Conradi, Lenard
AU - Bae, Richard
AU - Burke, Robert F
AU - Schäfer, Ulrich
AU - Lisko, John C
AU - Riley, Robert D
AU - Guyton, Robert
AU - Dumonteil, Nicolas
AU - Berthoumieu, Pierre
AU - Tchetche, Didier
AU - Blanke, Philipp
AU - Cavalcante, João L
AU - Sun, Benjamin
N1 - Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2019/9/17
Y1 - 2019/9/17
N2 - BACKGROUND: Treatment of mitral regurgitation (MR) in the setting of severe mitral annular calcification (MAC) is challenging due to the high risk for fatal atrioventricular groove disruption and significant paravalvular leak.OBJECTIVES: The objective of this study was to evaluate the potential for transcatheter mitral valve replacement in patients with severe MAC using an anatomically designed mitral prosthesis.METHODS: Nine patients (77 ± 6 years of age; 5 men) were treated with the valve, using transapical delivery performed under general anesthesia and with guidance from transesophageal echocardiography and fluoroscopy.RESULTS: Device implantation was successful with relief of MR in all 9 patients. There were no procedural deaths. In 1 patient, left ventricular outflow tract obstruction occurred due to malrotation of the prosthesis, and successful alcohol septal ablation was performed. During a median follow-up of 12 months (range 1 to 28 months), there was 1 cardiac death, 1 noncardiac death, no other mortality, and no prosthetic dysfunction, and MR remained absent in all treated patients. Rehospitalization for heart failure occurred in 2 patients who did not die subsequently. Clinical improvement with mild or no symptoms occurred in all patients alive at the end of follow-up.CONCLUSIONS: Transcatheter mitral valve replacement in severe mitral annular calcification with a dedicated prosthesis is feasible and can result in MR relief with symptom improvement. Further evaluation of this approach for these high-risk patients is warranted.
AB - BACKGROUND: Treatment of mitral regurgitation (MR) in the setting of severe mitral annular calcification (MAC) is challenging due to the high risk for fatal atrioventricular groove disruption and significant paravalvular leak.OBJECTIVES: The objective of this study was to evaluate the potential for transcatheter mitral valve replacement in patients with severe MAC using an anatomically designed mitral prosthesis.METHODS: Nine patients (77 ± 6 years of age; 5 men) were treated with the valve, using transapical delivery performed under general anesthesia and with guidance from transesophageal echocardiography and fluoroscopy.RESULTS: Device implantation was successful with relief of MR in all 9 patients. There were no procedural deaths. In 1 patient, left ventricular outflow tract obstruction occurred due to malrotation of the prosthesis, and successful alcohol septal ablation was performed. During a median follow-up of 12 months (range 1 to 28 months), there was 1 cardiac death, 1 noncardiac death, no other mortality, and no prosthetic dysfunction, and MR remained absent in all treated patients. Rehospitalization for heart failure occurred in 2 patients who did not die subsequently. Clinical improvement with mild or no symptoms occurred in all patients alive at the end of follow-up.CONCLUSIONS: Transcatheter mitral valve replacement in severe mitral annular calcification with a dedicated prosthesis is feasible and can result in MR relief with symptom improvement. Further evaluation of this approach for these high-risk patients is warranted.
KW - Aged
KW - Aged, 80 and over
KW - Calcinosis/surgery
KW - Cardiac Catheterization
KW - Female
KW - Heart Valve Diseases/surgery
KW - Heart Valve Prosthesis Implantation/methods
KW - Humans
KW - Male
KW - Mitral Valve/surgery
KW - Severity of Illness Index
U2 - 10.1016/j.jacc.2019.07.069
DO - 10.1016/j.jacc.2019.07.069
M3 - SCORING: Journal article
C2 - 31514943
VL - 74
SP - 1431
EP - 1440
JO - J AM COLL CARDIOL
JF - J AM COLL CARDIOL
SN - 0735-1097
IS - 11
ER -