Transcatheter Mitral Valve Replacement: State of the Art

Goode, Dylan; Dhaliwal, Ruby; Mohammadi, Hadi

doi:10.1007/s13239-020-00460-4

Cited by 28 publications

(30 citation statements)

References 78 publications

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“…With the rapid development of transcatheter valve surgery, transcatheter valve implantation for failed bioprosthetic valves (a valve-in-valve procedure) is emerging as another attractive alternative to conventional surgical valve replacement (25). However, the main causes leading to re-MVR are failed mitral valve repair and structural deterioration of prosthetic valve.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of a totally thoracoscopic approach for reoperative mitral valve replacement: a propensity score matched analysis

Wei¹,

Liu²,

Ma³

et al. 2021

Ann Transl Med

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Background: This study aimed to summarize the perioperative and long-term outcomes of patients with previous mitral valve surgery (MVS) undergoing reoperative mitral valve replacement (MVR). Methods: Data for all reoperative mitral valve replacements (re-MVRs) with or without concomitant tricuspid surgery were analyzed from Guangdong Provincial People's Hospital between January 2013 and December 2019. Propensity score matching resulted in 30 matched pairs with improved balance after matching in baseline covariates. Perioperative data and long-term clinical outcomes were analyzed.Results: Results are based on the matched cohorts between the two groups. The in-hospital mortality was 3.3% (two deaths) in the entire cohort and was not significantly different between the median sternotomy (MS) group and the totally thoracoscopic (TT) group. Most patients in the TT group had their tracheal intubation removed within 24 hours of surgery. The TT group had a diminished requirement for blood transfusion and a reduced 4-day postoperative chest tube drainage amount. The incidence of early major complications, including all-cause death and reoperation due to bleeding, was lower in the TT group. No significant differences were observed in the 7-year survival probability between the two groups. Conclusions:The encouraging results regarding the perioperative and long-term outcomes of patients who underwent a TT re-MVR show that this approach is particularly beneficial for patients requiring reoperation.

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Section: Discussionmentioning

confidence: 99%

Long-term outcomes of a totally thoracoscopic approach for reoperative mitral valve replacement: a propensity score matched analysis

Wei¹,

Liu²,

Ma³

et al. 2021

Ann Transl Med

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“…[ 190 ] TMVR is in an earlier stage where preclinical and clinical trials have shown promising results, showcasing the feasibility of the procedure. [ 191 ] However, there is still uncertainty about TAVR and TMVR durability and long‐term function. Although the latest test data from the PARTNER 3 trial shows TAVR has lower re‐hospitalization and primary endpoint rates than SAVR after one year, this difference is diminished after two years as thrombosis is observed in TAVR.…”

Section: Current Trends and Future Directionsmentioning

confidence: 99%

Transcatheter Heart Valves: A Biomaterials Perspective

Bui

Khair

Yeats

et al. 2021

Adv Healthcare Materials

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Heart valve disease is prevalent throughout the world, and the number of heart valve replacements is expected to increase rapidly in the coming years. Transcatheter heart valve replacement (THVR) provides a safe and minimally invasive means for heart valve replacement in high‐risk patients. The latest clinical data demonstrates that THVR is a practical solution for low‐risk patients. Despite these promising results, there is no long‐term (>20 years) durability data on transcatheter heart valves (THVs), raising concerns about material degeneration and long‐term performance. This review presents a detailed account of the materials development for THVRs. It provides a brief overview of THVR, the native valve properties, the criteria for an ideal THV, and how these devices are tested. A comprehensive review of materials and their applications in THVR, including how these materials are fabricated, prepared, and assembled into THVs is presented, followed by a discussion of current and future THVR biomaterial trends. The field of THVR is proliferating, and this review serves as a guide for understanding the development of THVs from a materials science and engineering perspective.

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“…LVOTO represents a life-threatening complication with 62% in-hospital mortality [ 16 ], and has been described after transcatheter mitral valve-in-ring procedures as well [ 17 ]. Thus, considering the larger prothesis size in TMVR, LVOTO constitutes a decisive design obstacle [ 18 ]. TMVR-induced LVOTO has been related to two mechanisms: Fixed obstruction, which follows anterior MV leaflet shifting toward the interventricular septum by the TMVR prosthesis, creating a narrowed and elongated neo-LVOT [ 19 ]; and dynamic obstruction, which is predisposed by long anterior MV leaflet and relies on Bernoulli forces rendered by the narrowed neo-LVOT that pull the anterior MV leaflet toward the interventricular septum during systole [ 20 , 21 ].…”

Section: Anatomical Structure and Subsequent Prosthesis Design Challengesmentioning

confidence: 99%

“…The native leaflets and chordae are to be preserved and leveraged to seal around the device [ 51 ]. To date, the device is implanted via transapical access (35 Fr) under rapid ventricular pacing, and the system has been improved to be recapturable up to the point of final release [ 18 ]. The early experience has been published by Bapat et al in 2018 [ 52 ].…”

Section: Devices and Clinical Experiencesmentioning

confidence: 99%

“…4 ) TMVR system (Abbott Laboratories, Abbott Park, IL, USA) consists of a transapically delivered (34 Fr) trileaflet porcine pericardial valve on a self-expanding nitinol double frame stent and adjustable tether with an apical fixation pad [ 43 ]. While the outer stent is available in multiple sizes and D-shaped to adapt to the anatomy of the mitral annulus, the inner stent has a circular shape [ 18 ]. The valve is attached to the LV apex by a the epicardially fixed locking pad.…”

Section: Devices and Clinical Experiencesmentioning

confidence: 99%

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Current Status of Catheter-based Mitral Valve Replacement

et al. 2021

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Purpose of review Transcatheter mitral valve replacement (TMVR) has been developed to address the need for an alternative therapeutic option to surgery in patients suffering from severe mitral regurgitation who are at high surgical risk. The present review illustrated the state-of-the-art of catheter-based mitral valve replacement evaluating technical characteristics and early clinical experience of different devices to outline prospects and challenges of TMVR. Recent findings Several devices are currently under clinical assessment. Early experience has demonstrated high procedural success of TMVR. However, TMVR faces several possible hurdles such as left ventricular outflow tract obstruction (LVOTO) after prosthesis deployment, access site complications, and thrombotic risk requiring anticoagulatory therapy. Summary Future studies should assess long-term prosthesis stability, optimal anticoagulation regime, and occurrence of paravalvular leakage. The development of smaller TMVR prostheses suitable for transseptal implantation could overcome bleeding complications. In perspective, TMVR may emerge to a clinically relevant therapeutic approach for patients with severe MR at high surgical risk.

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Transcatheter Mitral Valve Replacement: State of the Art

Cited by 28 publications

References 78 publications

Long-term outcomes of a totally thoracoscopic approach for reoperative mitral valve replacement: a propensity score matched analysis

Long-term outcomes of a totally thoracoscopic approach for reoperative mitral valve replacement: a propensity score matched analysis

Transcatheter Heart Valves: A Biomaterials Perspective

Current Status of Catheter-based Mitral Valve Replacement

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