Open Atrial Transcatheter Mitral Valve Replacement in Patients With Mitral Annular Calcification

Russell, Hyde M.; Guerrero, Mayra; Salinger, Michael H.; Manzuk, Melissa A.; Pursnani, Amit; Wang, Dee; Nemeh, Hassan; Sakhuja, Rahul; Melnitchouk, Serguei; Pershad, Ashish; Fang, Hao; Said, Sameh M.; Kauten, James; Tang, Gilbert H.L.; Aldea, Gabriel S.; Feldman, Ted; Bapat, Vinayak; George, Isaac

doi:10.1016/j.jacc.2018.07.033

Cited by 88 publications

(67 citation statements)

References 40 publications

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“…Transatrial TMVR is a hybrid approach whereby the mitral valve is exposed surgically via left atrial access and the balloon‐expandable valve is deployed directly into the mitral annulus. If LVOTO risk is deemed high, the surgeon can resect the anterior leaflet and/or perform a basal septal myectomy 7 . However, not all patients are good candidates for such an invasive approach.…”

Section: Discussionmentioning

confidence: 99%

A novel technique—Prophylactic septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement (RADIO‐TMVR)

Killu

Guerrero

Siontis

et al. 2020

Cardiovasc electrophysiol

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Transcatheter mitral valve replacement (TMVR) with off‐label use of aortic balloon‐expandable transcatheter heart valves has emerged as a therapeutic option in high‐surgical risk patients with severe mitral annular calcification. Left ventricular outflow tract (LVOT) obstruction post valve deployment is a major limitation. We describe a case of septal reduction therapy using radiofrequency ablation (RFA) when established methods of septal reduction were either ineffective or not feasible. RFA permitted successful enlargement of the LVOT area and subsequent TMVR.

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Section: Discussionmentioning

confidence: 99%

A novel technique—Prophylactic septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement (RADIO‐TMVR)

Killu

Guerrero

Siontis

et al. 2020

Cardiovasc electrophysiol

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“…TMVR may lead to hemolysis by shear stress placed on RBCs passing through non‐endothelialized PVL channels or through cells of the mitral prosthesis that may protrude in the LVOT. The incidence of hemolysis in prior series of TMVR has been reported between 4 and 40% 3,7,8 . This wide range is likely related to differences in definitions of hemolysis and TMVR technique.…”

Section: Discussionmentioning

confidence: 99%

Acute fulminant hemolysis after transcatheter mitral valve replacement for mitral annular calcification

El‐Sabawi

Guerrero

Eleid

et al. 2020

Cathet Cardio Intervent

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Transcatheter mitral valve replacement (TMVR) is emerging as an alternative treatment strategy to surgery for patients with severe mitral annular calcification (MAC) who are not candidates for traditional mitral valve surgery. Paravalvular leak (PVL) is common following TMVR for severe MAC and can lead to heart failure symptoms and/or intravascular hemolysis, the latter of which usually is clinically stable. We report the case of a 67‐year‐old woman with symptomatic severe aortic stenosis and mitral stenosis with MAC in the setting of prior chest irradiation who was treated initially with transcatheter aortic valve replacement followed by TMVR at a later date (Sapien S3 system; Edwards Lifesciences). Immediately following TMVR, she developed acute profound hemolysis which manifested with hemoglobinuria, transfusion‐dependent anemia, and acute renal failure requiring renal replacement therapy. She was treated with post‐dilation balloon valvuloplasty after failed transcatheter PVL closure 10 days following TMVR with resulting improvement in the PVL. The hemolytic anemia resolved and renal function recovered without the need for continued hemodialysis 2 months later and stabilization of glomerular filtration rate at 6 months. This case highlights a potential severe complication of TMVR in MAC and suggests that improvement in hemolysis and late recovery of renal function may occur following treatment of PVL.

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“…He weighed 83 kg and his height was 178 cm, access is an option with excellent outcomes. 3 It allows removal of the anterior mitral leaflet under direct view to minimize the risk of left ventricular outflow tract obstruction. 3 Alternatively, based on the same concept, the LAMPOON transcatheter technique splits the anterior mitral leaflet percutaneously before transcatheter ViMAC.…”

Section: Case Reportmentioning

confidence: 99%

“…3 It allows removal of the anterior mitral leaflet under direct view to minimize the risk of left ventricular outflow tract obstruction. 3 Alternatively, based on the same concept, the LAMPOON transcatheter technique splits the anterior mitral leaflet percutaneously before transcatheter ViMAC. 4 Transcatheter mitral ViV procedures have excellent outcomes in high-risk patients with degenerated mitral bioprostheses.…”

Section: Case Reportmentioning

confidence: 99%

Transcatheter “valve‐in‐valve” mitral valve replacement for patient‐prosthesis mismatch: Chronicle of a death foretold

et al. 2020

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Severe mitral annular calcification (MAC) may represent a challenging issue which can lead to poor outcomes and serious issues such as patient-prosthesis mismatch (PPM). The potential harmful effect of PPM must be prevented through the use of alternative techniques that allow mitral valve replacement with adequately sized bioprostheses in patients with MAC. PPM should be recognized as a contraindication for transcatheter valve-in-valve replacement as it leads to poor outcomes and early prosthetic degeneration.

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Open Atrial Transcatheter Mitral Valve Replacement in Patients With Mitral Annular Calcification

Cited by 88 publications

References 40 publications

A novel technique—Prophylactic septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement (RADIO‐TMVR)

A novel technique—Prophylactic septal radiofrequency ablation to prevent left ventricular outflow tract obstruction with transcatheter mitral valve replacement (RADIO‐TMVR)

Acute fulminant hemolysis after transcatheter mitral valve replacement for mitral annular calcification

Transcatheter “valve‐in‐valve” mitral valve replacement for patient‐prosthesis mismatch: Chronicle of a death foretold

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