Transcatheter mitral valve-in-valve implantation in patients with degenerated bioprostheses
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Transcatheter mitral valve-in-valve implantation in patients with degenerated bioprostheses. / Seiffert, Moritz; Conradi, Lenard; Baldus, Stephan; Schirmer, Johannes; Knap, Malgorzata; Blankenberg, Stefan; Reichenspurner, Hermann; Treede, Hendrik.
in: JACC-CARDIOVASC INTE, Jahrgang 5, Nr. 3, 03.2012, S. 341-349.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Transcatheter mitral valve-in-valve implantation in patients with degenerated bioprostheses
AU - Seiffert, Moritz
AU - Conradi, Lenard
AU - Baldus, Stephan
AU - Schirmer, Johannes
AU - Knap, Malgorzata
AU - Blankenberg, Stefan
AU - Reichenspurner, Hermann
AU - Treede, Hendrik
N1 - Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2012/3
Y1 - 2012/3
N2 - OBJECTIVES: This study reports the results of a series of transapical mitral valve-in-valve implantations and aims to offer guidance on technical aspects of the procedure.BACKGROUND: Mitral valve reoperations due to failing bioprostheses are associated with high morbidity and mortality. Transcatheter techniques may evolve as complementary approaches to surgery in these high-risk patients.METHODS: Six patients (age 75 ± 15 years) received transapical implantation of a balloon-expandable pericardial heart valve into a degenerated bioprosthesis (range 27 to 31 mm) in mitral position at our institution. All patients were considered high risk for surgical valve replacement (logistic EuroSCORE: 33 ± 15%) after evaluation by an interdisciplinary heart team. Procedural and clinical outcomes were analyzed.RESULTS: Implantation was successful in all patients with reduction of mean transvalvular gradients from 11.3 ± 5.2 mm Hg to 5.5 ± 3.6 mm Hg (p = 0.016) and median regurgitation from grade 3.0 (interquartile range [IQR]: 2.7 to 3.1) to 0 (IQR: 0 to 1.0, p = 0.033) with trace paravalvular regurgitation remaining in 2 patients. Apical bleeding occurred in 2 patients requiring rethoracotomy in 1 and resuscitation in a second patient, the latter of whom died on postoperative day 6. In the remaining patients, median New York Heart Association functional class improved from 3.0 (IQR: 3.0 to 3.5) to 2.0 (IQR: 1.5 to 2.0, p = 0.048) over a median follow-up of 70 (IQR: 25.5 to 358) days.CONCLUSIONS: With acceptable results in a high-risk population, transapical mitral valve-in-valve implantation can be considered as a complementary approach to reoperative mitral valve surgery in select patients.
AB - OBJECTIVES: This study reports the results of a series of transapical mitral valve-in-valve implantations and aims to offer guidance on technical aspects of the procedure.BACKGROUND: Mitral valve reoperations due to failing bioprostheses are associated with high morbidity and mortality. Transcatheter techniques may evolve as complementary approaches to surgery in these high-risk patients.METHODS: Six patients (age 75 ± 15 years) received transapical implantation of a balloon-expandable pericardial heart valve into a degenerated bioprosthesis (range 27 to 31 mm) in mitral position at our institution. All patients were considered high risk for surgical valve replacement (logistic EuroSCORE: 33 ± 15%) after evaluation by an interdisciplinary heart team. Procedural and clinical outcomes were analyzed.RESULTS: Implantation was successful in all patients with reduction of mean transvalvular gradients from 11.3 ± 5.2 mm Hg to 5.5 ± 3.6 mm Hg (p = 0.016) and median regurgitation from grade 3.0 (interquartile range [IQR]: 2.7 to 3.1) to 0 (IQR: 0 to 1.0, p = 0.033) with trace paravalvular regurgitation remaining in 2 patients. Apical bleeding occurred in 2 patients requiring rethoracotomy in 1 and resuscitation in a second patient, the latter of whom died on postoperative day 6. In the remaining patients, median New York Heart Association functional class improved from 3.0 (IQR: 3.0 to 3.5) to 2.0 (IQR: 1.5 to 2.0, p = 0.048) over a median follow-up of 70 (IQR: 25.5 to 358) days.CONCLUSIONS: With acceptable results in a high-risk population, transapical mitral valve-in-valve implantation can be considered as a complementary approach to reoperative mitral valve surgery in select patients.
KW - Aged
KW - Aged, 80 and over
KW - Bioprosthesis
KW - Cardiac Catheterization/adverse effects
KW - Catheterization
KW - Female
KW - Germany
KW - Heart Valve Diseases/surgery
KW - Heart Valve Prosthesis
KW - Heart Valve Prosthesis Implantation/adverse effects
KW - Humans
KW - Logistic Models
KW - Middle Aged
KW - Mitral Valve/diagnostic imaging
KW - Prosthesis Design
KW - Prosthesis Failure
KW - Radiography
KW - Retrospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
KW - Ultrasonography
U2 - 10.1016/j.jcin.2011.12.008
DO - 10.1016/j.jcin.2011.12.008
M3 - SCORING: Journal article
C2 - 22440502
VL - 5
SP - 341
EP - 349
JO - JACC-CARDIOVASC INTE
JF - JACC-CARDIOVASC INTE
SN - 1936-8798
IS - 3
ER -