Transcatheter aortic valve implantation in patients with a mitral prosthesis; single center experience and review of literature

Asil, Serkan; Şahiner, Levent; Özer, Necla; Kaya, Ergün Barış; Evranos, Banu; Canpolat, Uğur; Yorgun, Hikmet; Karagoz, Heves; Aytemir, Kudret

doi:10.1016/j.ijcard.2016.07.051

Cited by 11 publications

(10 citation statements)

References 21 publications

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“…The THV implantation depth was less than the distance between the mitral prosthesis and native annulus, except in case #16, which means the THV was properly implanted without interference with the mitral prosthesis. The operators successfully managed the position of THV that was very close to the mitral prosthesis housing (median 2.6 mm), by applying a technique described in previous reports, such as slow THV deployment [4,5,9,11]. Moreover, the predominant use of general anesthesia in the present study (80.6%) might reflect the operators’ consideration that general anesthesia with controlled ventilation and transesophageal echocardiographic guidance can make THV deployment more secure in this challenging situation [11].…”

Section: Discussionmentioning

confidence: 99%

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Previously implanted mitral surgical prosthesis in patients undergoing transcatheter aortic valve implantation: Procedural outcome and morphologic assessment using multidetector computed tomography

et al. 2019

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Transcatheter aortic valve implantation (TAVI) in the presence of a preexisting mitral prosthesis is challenging and its influence on the morphology of mitral prosthesis and the positioning of transcatheter heart valve (THV) is unknown. We assessed the feasibility of TAVI for patients with preexisting mitral prostheses, its influence on mitral prosthesis morphology, and the positional interaction between a newly implanted THV and mitral prosthesis using serial multidetector computed tomography (MDCT). Thirty-one patients with preexisting mitral prosthesis undergoing TAVI were included. MDCT was performed before and after TAVI. Thirty patients successfully underwent TAVI without interference from preexisting mitral prosthesis. Although opening disturbance of the mechanical mitral prosthesis by the THV edge was observed in 1 patient, the patient was managed conservatively. No THV embolization occurred. THV shift during deployment occurred in 9 patients and was predicted by a larger aortic annulus area (odds ratio: 1.24 per 10 mm2, 1.03–1.49, p = 0.02), possibly because of large THVs. The mitral mean pressure gradient was slightly higher after TAVI (3.7 vs. 4.3 mmHg, p = 0.002), whereas the mitral regurgitation grade was similar. MDCT showed that the size of the mitral prosthesis housing was unchanged after TAVI. The median distance between the mitral prosthesis and THV was 2.6 mm. The postprocedural angle between the mitral prosthesis and THV was larger than the preprocedural angle between the mitral prosthesis and the left ventricular outflow tract (64° vs. 61°, p = 0.03). Thus, TAVI is feasible in the case of preexisting mitral prosthesis. Serial MDCT demonstrated favorable THV positioning and unchanged mitral prosthesis morphology after TAVI.

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Section: Discussionmentioning

confidence: 99%

“…One registry and several case series have reported the feasibility of TAVI in this situation [4–6,9–16]. A previous report demonstrated favorable outcomes in 91 patients with preexisting mitral prostheses who underwent TAVI [6].…”

Section: Introductionmentioning

confidence: 99%

Previously implanted mitral surgical prosthesis in patients undergoing transcatheter aortic valve implantation: Procedural outcome and morphologic assessment using multidetector computed tomography

et al. 2019

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“…Although TAVI patients with a history of any previous cardiac surgery constitute up to 30% of all TAVI patients, the large national registries [2][3][4][5] surprisingly do not specifically mention post-MVR patients. Probably the first report of TAVI (via the apical approach) in a patient with previous MVR was reported in 2008 [6], followed by one large Spanish registry of 91 patients [7], small series [8][9][10][11][12][13] and single cases [14][15][16][17][18][19][20] (for literature overview see Table I). Current European guidelines on acquired heart valve disease do not cover this valvular scenario.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter aortic valve replacement in patients with previous mitral valve replacement. A systematic study

Chmielak¹,

Dąbrowski²,

Tyczyński³

et al. 2020

pwki

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Introduction: Severe aortic stenosis (AS) is an ever-growing healthcare problem in ageing populations. Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of AS. However, TAVI in patients who have undergone mitral valve replacement (MVR) is associated with increased risk of mitral valve damage. Limited data exist on TAVI in patients with AS who underwent MVR in the past. Aim: To retrospectively assess the clinical characteristics, detailed echocardiographic and computed tomography measurements, procedural and in-hospital outcome as well as any valve intervention or major adverse cardiovascular events according to VARC-2 criteria at follow-up of patients with a history of MVR, who underwent TAVI. Material and methods: Seventeen patients with a history of mitral valve operation, in whom TAVI was performed between 2010 and 2018, were identified. Of these, 15 underwent previous MVR. Results: Overall, TAVI resulted in a decrease of mean transaortic gradient by 38.3 ±14 mm Hg (p < 0.001) and a decrease of maximal transaortic gradient by 58.6 ±27.6 mm Hg (p < 0.001). A successful immediate result was obtained in 14 (93.3%) patients. One tamponade occurred during TAVI, which was successfully treated with pericardiocentesis. Post-procedurally, no significant changes in transmitral gradients or mitral regurgitations were observed. Two patients died after hospital discharge, one due to possible internal bleeding and the other due to infection. Conclusions: TAVI in patients after MVR is feasible. Meticulous preinterventional echocardiographic and computed tomography planning is essential. Although recommended in previous reports, TEE guidance may not necessarily be obligatory during the procedure.

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“…Such interaction could damage the mitral prosthesis or impair the deployment of the transcatheter valve, resulting in paravalvular leak (PVL) or valve embolization. 8,9 Despite these concerns, numerous reports have described TAVR in patients with prior SMVR, the majority of which were successful. However, these series were limited by small sample size and thus lack significant power for meaningful analysis.…”

mentioning

confidence: 99%

Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry

Thourani

Kelly

Cervantes

et al. 2020

The Annals of Thoracic Surgery

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Transcatheter aortic valve implantation in patients with a mitral prosthesis; single center experience and review of literature

Cited by 11 publications

References 21 publications

Previously implanted mitral surgical prosthesis in patients undergoing transcatheter aortic valve implantation: Procedural outcome and morphologic assessment using multidetector computed tomography

Previously implanted mitral surgical prosthesis in patients undergoing transcatheter aortic valve implantation: Procedural outcome and morphologic assessment using multidetector computed tomography

Transcatheter aortic valve replacement in patients with previous mitral valve replacement. A systematic study

Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry

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