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Background. Re-operative mitral valve (MV) replacement is a high-risk procedure, therefore, transcatheter MV replacement (TMVR) is a promising therapeutic option. Aim. In this study, we aimed to evaluate the feasibility and safety of TMVR in patients with high surgical risk with degenerated mitral bioprostheses (TMViV), failed surgical rings (TMViR), and mitral annular calcification (TMViMAC). Methods. This is a retrospective cohort study that enrolled patients with high surgical risk who underwent TMVR from February 2017 to September 2020. The TMVR procedure was performed using Edwards SAPIEN-3 valves through the transseptal approach. Results. Sixty-four patients aged 62.7 ± 16.1 years with an STS score of 9.2 ± 3.7% underwent TMVR [35 (55%) TMViV, 16 (25%) TMViR, and 13 (20%) TMViMAC]. Mitral stenosis was more frequent in TMViV, mitral regurgitation was more frequent in TMViR, and combined mitral stenosis and regurgitation were more frequent in TMViMAC ( P < 0.05 ). The MV gradient was 14.3 ± 5.3 mmHg and the MV area was 1.5±0.6 cm2. The 29 mm valve was frequently used in TMViV and TMViMAC, while the 23 mm valve was frequently used in TMViR ( P = 0.003 ∗ ). The procedural and fluoroscopy times were 58.7 ± 8.9 and 41.1 ± 8.2 minutes, respectively. Technical success was reported in 62 (98.4%) patients; 1 TMViR patient experienced valve embolization and salvage surgery, and 1 TMViMAC patient experienced slight valve malposition. At 3 months, 2 (3.1%) patients showed valve thrombosis (treated with anticoagulation), and 1 (1.6%) patient developed a paravalvular leak (underwent surgical MV replacement). At 6 months, 3 (4.7%) patients showed valve degeneration (underwent surgical MV replacement). Throughout follow-up, no patient exhibited mortality. Conclusions. TMVR is a feasible and safe approach in patients with high surgical risk. TMViV and TMViR are reasonable as the first treatment approaches, and TMViMAC seems encouraging.

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Aim This study aimed to review our center experience in transcatheter closure of post-surgical and post-intervention residual and iatrogenic VSDs and to report on their 12-month long-term outcome. Methods All patients who underwent transcatheter closure of residual ventricular septal defects (R-VSDs) and iatrogenic ventricular septal defects (I-VSDs) after either surgical corrections or transcatheter interventions for any congenital heart disease (CHD) between January 2015 and January 2020 were included in the study. Patients' medical records were reviewed and analyzed. Results Twenty-three patients with a mean age of 14.3 ± 8.8 years, a mean weight of 36.2 ± 20.4 Kg, and a mean body surface area of 1.18 ± 0.36 m2 were included. Thirteen (56.5%) patients were males. The VSD was residual in 18 (78.3%) patients and iatrogenic in 5 (21.7%) patients, post-operative in 19 (82.6%) patients and post-transcatheter in 4 (17.4%) patients. The remaining VSD site was peri-membranous in 9 (39.1%) patients, high-muscular in 6 (26.1%) patients, mid-muscular in 4 (17.4%) patients, and Gerbode shunt in 4 (17.4%) patients. The QP/QS ratio was 2.5 ± 0.7, and the VSD diameter was 6.1±2.1 mm with a VSD-aorta rim of 5.4 ± 2.0 mm. Most, 16 (71.43%) patients underwent antegrade device deployment, and 7 (28.57%) patients underwent retrograde transaortic device deployment, with only 3 (13.0%) patients required two devices/patient. Amplatzer™ Muscular VSD devices were used in 16 (69.6%) patients, Amplatzer™ Duct occlude-I devices were used in 4 (17.4%) patients, and Amplatzer™ Duct Occluder-II devices were used in 3 (13.0%) patients with a mean device size of 8.8 ± 2.8 mm. The mean procedural time was 55.1 ± 16.2 minutes, fluoroscopy time was 16.3 ± 4.0 minutes, and the contrast used was 33.8 ± 10.9 ml. Concomitant balloon pulmonary valvuloplasty was done at the same catheterization set in 2 (8.7%) patients. Acute procedural success, satisfactory immediate were achieved in all patients. During follow-up (23.3 ± 15.9 months), no patient required re-intervention or exhibited mortality. Conclusions Transcatheter closure of post-operative, and post-intervention residual and iatrogenic VSDs represents an attractive therapeutic approach. This approach is safe, feasible, effective, and less invasive alternative treatment option for such remaining VSDs.

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