How Do Transcatheter Heart Valves Fit in Mitral Annuloplasty Rings and Which Combination Can be Recommended?

The past decade has been a revolution in the use of percutaneous procedures for mitral valve (MV) therapy, and currently there are several devices in different stages of development. The enhanced imaging with 3D transoesophageal echocardiography (TEE), as well as computed tomography (CT) and fusion imaging, has led to better understanding of MV anatomy, which in turn helped promote the development of new devices, as well as being crucial for procedural guidance and effective valve repair or replacement. In addition to the new devices, fusion imaging promises to result in even better outcomes in the future by enhancing device deployment. While initially device development for the MV focused on degenerative mitral regurgitation (MR), more recent studies have demonstrated that reducing the severity of secondary MR with transcatheter techniques may provide symptomatic benefit with regards to cardiac heart failure and improved survival. Percutaneous therapies for the MV, as they are less invasive, have many advantages that may supplant surgical techniques, provided that they reduce morbidity and mortality and have comparable efficacy. In this chapter we review transcatheter MV interventions for mitral stenosis (MS) and MR.

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Reoperative Mitral Surgery Versus Transcatheter Mitral Valve Replacement: A Systematic Review

Sengupta

Yazdchi

Alexis

et al. 2021

JAHA

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Bioprosthetic mitral structural valve degeneration and failed mitral valve repair (MVr) have traditionally been treated with reoperative mitral valve surgery. Transcatheter mitral valve‐in‐valve (MVIV) and valve‐in‐ring (MVIR) replacement are now feasible, but data comparing these approaches are lacking. We sought to compare the outcomes of (1) reoperative mitral valve replacement (redo‐MVR) and MVIV for structural valve degeneration, and (2) reoperative mitral valve repair (redo‐MVr) or MVR and MVIR for failed MVr. A literature search of PubMed, Embase, and the Cochrane Library was conducted up to July 31, 2020. Thirty‐two studies involving 25 832 patients were included. Redo‐MVR was required in ≈35% of patients after index surgery at 10 years, with 5% to 15% 30‐day mortality. MVIV resulted in >95% procedural success with 30‐day and 1‐year mortality of 0% to 8% and 11% to 16%, respectively. Recognized complications included left ventricular outflow tract obstruction (0%–6%), valve migration (0%–9%), and residual regurgitation (0%–6%). Comparisons of redo‐MVR and MVIV showed no statistically significant differences in mortality (11.3% versus 11.9% at 1 year, P =0.92), albeit higher rates of major bleeding and arrhythmias with redo‐MVR. MVIR resulted in 0% to 34% mortality at 1 year, whereas both redo‐MVr and MVR for failed repairs were performed with minimal mortality and durable long‐term results. MVIV is therefore a viable alternative to redo‐MVR for structural valve degeneration, whereas redo‐MVr or redo‐MVR is preferred for failed MVr given the suboptimal results with MVIR. However, not all patients will be candidates for MVIV/MVIR because anatomical restrictions may preclude transcatheter options from adequately addressing the underlying pathology.

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How Do Transcatheter Heart Valves Fit in Mitral Annuloplasty Rings and Which Combination Can be Recommended?

Cited by 3 publications

References 28 publications

Mitral Valve Annuloplasty Failure and Percutaneous Treatment Options

Mitral Valve Annuloplasty Failure and Percutaneous Treatment Options

Transcatheter mitral valve interventions

Reoperative Mitral Surgery Versus Transcatheter Mitral Valve Replacement: A Systematic Review

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