ABSTRACT
OBJECTIVES: This study sought to evaluate the outcomes of the early experience of transcatheter mitral valve replacement (TMVR) with balloon-expandable valves in patients with severe mitral annular calcification (MAC) and reports the first large series from a multicenter global registry. BACKGROUND: The risk of surgical mitral valve replacement in patients with severe MAC is high. There are isolated reports of successful TMVR with balloon-expandable valves in this patient population. METHODS: We performed a multicenter retrospective review of clinical outcomes of patients with severe MAC undergoing TMVR. RESULTS: From September 2012 to July of 2015, 64 patients in 32 centers underwent TMVR with compassionate use of balloon-expandable valves. Mean age was 73 ± 13 years, 66% were female, and mean Society of Thoracic Surgeons score was 14.4 ± 9.5%. The mean mitral gradient was 11.45 ± 4.4 mm Hg and the mean mitral area was 1.18 ± 0.5 cm(2). SAPIEN valves (Edwards Lifesciences, Irvine, California) were used in 7.8%, SAPIEN XT in 59.4%, SAPIEN 3 in 28.1%, and Inovare (Braile Biomedica, Brazil) in 4.7%. Access was transatrial in 15.6%, transapical in 43.8%, and transseptal in 40.6%. Technical success according to Mitral Valve Academic Research Consortium criteria was achieved in 46 (72%) patients, primarily limited by the need for a second valve in 11 (17.2%). Six (9.3%) had left ventricular tract obstruction with hemodynamic compromise. Mean mitral gradient post-procedure was 4 ± 2.2 mm Hg, paravalvular regurgitation was mild or absent in all. Thirty-day all-cause mortality was 29.7% (cardiovascular = 12.5% and noncardiac = 17.2%); 84% of the survivors with follow-up data available were in New York Heart Association functional class I or II at 30 days (n = 25). CONCLUSIONS: TMVR with balloon-expandable valves in patients with severe MAC is feasible but may be associated with significant adverse events. This strategy might be an alternative for selected high-risk patients with limited treatment options.
Subject(s)
Calcinosis/surgery , Cardiac Catheterization/methods , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/methods , Mitral Valve/surgery , Adult , Aged , Aged, 80 and over , Balloon Valvuloplasty , Calcinosis/diagnostic imaging , Calcinosis/mortality , Calcinosis/physiopathology , Cardiac Catheterization/adverse effects , Cardiac Catheterization/instrumentation , Cardiac Catheterization/mortality , Europe , Female , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/mortality , Heart Valve Diseases/physiopathology , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis Implantation/mortality , Humans , Male , Middle Aged , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , North America , Patient Selection , Postoperative Complications/etiology , Postoperative Complications/mortality , Prosthesis Design , Registries , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , South America , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
A valvuloplastia aórtica por balão voltou a ganhar interesse desde o início da era da substituição percutânea da valva aórtica, por ser um procedimento que pode ser repetido como ponte e também por ser boa estratégia para a seleção de pacientes para o novo procedimento. Método: De janeiro de 2001 a janeiro de 2009, 174 pacientes consecutivos com estenose aórtica sintomática grave e alto risco cirúrgico calculado pelo EuroSCORE/STS foram submetidos a valvuloplastia aórtica por balão na França e na Argentina, utilizando-se a mesma técnica. Desse total, 21 (12,1 por cento) precisaram repetir a valvuloplastia aórtica por balão em decorrência de reestenose e os resultados foram comparados aos dos 153 pacientes que realizaram somente o primeiro procedimento. A técnica mais utilizada foi o acesso retrógrado com abordagem femoral utilizando introdutores de 10 F, 12 F ou 14 F, com tamanhos de balão...