1-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Severe Mitral Annular Calcification

Guerrero, Mayra; Ureña, Marina; Himbert, Dominique; Wang, Dee Dee; Eleid, Mackram F.; Kodali, Susheel; George, Isaac; Chakravarty, Tarun; Mathur, Moses; Holzhey, David; Pershad, Ashish; Fang, Hao; O’Hair, Daniel; Jones, Noah; Mahadevan, Vaikom S.; Dumonteil, Nicolas; Rodés‐Cabau, Josep; Piazza, Nicolò; Ferrari, Enrico; Ciaburri, Daniel; Nejjari, Mohammed; Delago, Augustin; Sorajja, Paul; Zahr, Firas; Rajagopal, Vivek; Whisenant, Brian; Shah, Pinak; Sinning, Jan‐Malte; Witkowski, Adam; Eltchaninoff, Hélène; Dvir, Danny; Borggrefe, Martin; Attizzani, Guilherme F.; Gaia, Diego Felipe; Nunes, Nágela Simão Vinhosa; Fassa, Amir-Ali; Kerendi, Faraz; Pavlides, Gregory; Iyer, Vijay; Kaddissi, Georges; Witzke, Christian; Wudel, James H.; Mishkel, Gregory; Raybuck, Bryan; Wang, Chi; Waksman, Ron; Palacios, Igor F.; Cribier, Alain; Webb, John G.; Bapat, Vinayak; Reisman, Mark; Makkar, Raj; Leon, Martin B.; Rihal, Charanjit S.; Vahanian, Alec; O’Neill, William W.; Feldman, Ted

doi:10.1016/j.jacc.2018.02.054

Cited by 306 publications

(202 citation statements)

References 24 publications

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“…Successful surgical or percutaneous closure of mitral PVL reducing mitral regurgitation severity to mild or less is associated with significant improvement in survival and NYHA class heart failure compared with greater severity of residual regurgitation . Moderate to severe residual PVL at end of MTVR procedure (including post‐dilatation or PVL closure attempt in some) was reported in 4.9% of patients in the TMVR in MAC Global registry . Our experience revealed a higher rate of moderate to severe residual PVL after TMVR in MAC approaching 20%.…”

Section: Discussion and Lessons Learnedmentioning

confidence: 68%

“…obstruction and paravalvular leak (PVL) were high.. 8,9 In the TMVR in MAC Global Registry, 4.9% of the patients who underwent TMVR using a balloon-expandable aortic THV had residual PVL grade ≥ 3 (+) (moderate to severe) at the end of the TMVR procedure. 10 Higher rates of PVL have been noted in other reports. 11 There are currently no data available on optimal techniques for treatment of symptomatic PVL after TMVR in MAC with aortic balloon-expandable THV.…”

mentioning

confidence: 61%

“…. In the TMVR in MAC Global Registry, 4.9% of the patients who underwent TMVR using a balloon‐expandable aortic THV had residual PVL grade ≥ 3 (+) (moderate to severe) at the end of the TMVR procedure . Higher rates of PVL have been noted in other reports .…”

Section: Introductionmentioning

confidence: 77%

“…16,17 Moderate to severe residual PVL at end of MTVR procedure (including post-dilatation or PVL closure attempt in some) was reported in 4.9% of patients in the TMVR in MAC Global registry. 10 were performed successfully through transeptal approach, transapical access can be considered as it can provide coaxial trajectory for crossing anterior and medial PVL defects. However, apical access can carry higher risk of bleeding (e.g., hemothorax) which need to be considered in pre-procedural planning.…”

Section: Discussion and Lessons Learnedmentioning

confidence: 99%

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Paravalvular leak repair after balloon‐expandable transcatheter mitral valve implantation in mitral annular calcification: Early experience and lessons learned

Al‐Hijji

Sabbagh

Guerrero

et al. 2019

Cathet Cardio Intervent

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Background Treatment of hemodynamically significant mitral annular calcification (MAC) using transcatheter approaches is in the early learning phase. The occurrence of paravalvular leak (PVL) following transcatheter mitral valve in MAC is common. Aims To report the initial experience and techniques of percutaneous PVL closure after transcatheter valve in MAC. Methods This series includes five consecutive patients who underwent percutaneous PVL closure following transcatheter balloon expandable SAPIEN S3 valve in MAC. Results Mean patient age was 73.6 ± 5.4 years (4 [80%] female), with average Society of Thoracic Surgeons score of 8.1 ± 2.8%. Three patients had a single PVL defect while two patients had two defects; all were located at the commissural sites. Closure was performed primarily for heart failure in four patients and hemolytic anemia in one patient. Transfemoral transseptal antegrade approach and Amplatz Vascular Plug (AVP)‐II occluders were utilized in all patients. Procedure success was achieved in three patients. One patient developed significant occluder related leaflet impingement and subsequent severe prosthetic mitral regurgitation requiring a second transcatheter mitral valve in valve implantation. The procedure was aborted in one patient due to difficulty crossing PVL defect after balloon post‐dilatation of SAPIEN prosthesis with 10 mL of additional volume. There was no in hospital or 30 day mortality or the need for emergent surgery. Conclusion Early experience with percutaneous PVL closure of SAPIEN valve in MAC demonstrated feasibility of this approach. Careful procedure planning and monitoring for SAPIEN prosthesis leaflet impingement and frame instability is of utmost importance to increase the chances of procedural success.

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Section: Discussion and Lessons Learnedmentioning

confidence: 68%

mentioning

confidence: 61%

Section: Introductionmentioning

confidence: 77%

Section: Discussion and Lessons Learnedmentioning

confidence: 99%

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Paravalvular leak repair after balloon‐expandable transcatheter mitral valve implantation in mitral annular calcification: Early experience and lessons learned

Al‐Hijji

Sabbagh

Guerrero

et al. 2019

Cathet Cardio Intervent

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“…Left ventricular outflow tract (LVOT) obstruction can occur in 13% and up to 22% among the patients undergoing TMVR. [1][2][3][4][5][6] This can be related to multiple factors including aorto-mitral angle, LVOT dimensions, septal hypertrophy, and length of the anterior mitral leaflet (AML), among others. Preprocedural evaluation using echocardiography as well as cardiac CT is important in defining these factors.…”

Section: Introductionmentioning

confidence: 99%

Balloon assisted translocation of the mitral anterior leaflet to prevent left ventricular outflow obstruction (BATMAN): A novel technique for patients undergoing transcatheter mitral valve replacement

Helmy

Hui

Smart

et al. 2019

Cathet Cardio Intervent

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Introduction Transcatheter mitral valve replacement (TMVR) is an option for patients at high risk for mitral valve replacement or repair via sternotomy or left thoracotomy approach. TMVR carries up to 22% risk of left ventricular outflow tract (LVOT) obstruction. Severe LVOT obstruction can have devastating hemodynamic and clinical consequences. Hypothesis We previously presented a novel technique to prevent LVOT obstruction during transapical retrograde mitral valve replacement, by penetrating and ballooning the anterior mitral leaflet (AML), resulting in creation of a “hole” and posterior translocation of AML, then deploying the valve. Methods Three patients underwent TMVR at Saint Louis University for severe mitral regurgitation after being deemed too high risk for surgery, and not candidates for a Mitra‐clip procedure. These patients were deemed to be at risk for LVOT obstruction based on the preprocedural evaluation. Via transapical approach, a needle was advanced “through,” perforating the AML and wire was placed in the left atrium. Over the wire, an 20‐mm valvuloplasty balloon was positioned “within” the anterior leaflet and inflated leading to translocation of the AMVL. Then the valve was deployed. Results This novel technique has been performed on three patients at our institution. Sapien S3 transcatheter valves were used in all three patients, with 100% procedural success rate. Intraoperative TEE demonstrated no significant LVOT obstruction, cardiopulmonary bypass time was 42–44 min. Conclusion The balloon assisted translocation of the mitral anterior leaflet to prevent left ventricular outflow obstruction technique described here may offer the option of transcatheter mitral valve implantation in patients at high risk of LVOT obstruction. A variation of this technique to allow application in cases with transseptal approach is under investigation.

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Antithrombotic Strategies in Valvular and Structural Heart Disease Interventions

Camaj¹,

Razuk²,

Dangas³

2022

Interventional Cardiology

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1-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Severe Mitral Annular Calcification

Cited by 306 publications

References 24 publications

Paravalvular leak repair after balloon‐expandable transcatheter mitral valve implantation in mitral annular calcification: Early experience and lessons learned

Paravalvular leak repair after balloon‐expandable transcatheter mitral valve implantation in mitral annular calcification: Early experience and lessons learned

Balloon assisted translocation of the mitral anterior leaflet to prevent left ventricular outflow obstruction (BATMAN): A novel technique for patients undergoing transcatheter mitral valve replacement

Antithrombotic Strategies in Valvular and Structural Heart Disease Interventions

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