Open Atrial Transcatheter Mitral Valve Replacement in Patients With Mitral Annular Calcification.
J Am Coll Cardiol
; 72(13): 1437-1448, 2018 09 25.
Article
en En
| MEDLINE
| ID: mdl-30236304
ABSTRACT
BACKGROUND:
Mitral valve replacement in the setting of severe mitral annular calcification remains a surgical challenge. Transcatheter mitral valve replacement (TMVR) using an aortic balloon-expandable transcatheter heart valve is emerging as a potential treatment option for high surgical risk patients. Transseptal, transapical, or transatrial access is not always feasible, so an understanding of alternative implantation techniques is important.OBJECTIVES:
The authors sought to present a step-by-step description of a contemporary transatrial TMVR technique using balloon-expandable aortic transcatheter heart valves. This procedure has evolved over time to address valve migration, left ventricular outflow tract obstruction, and paravalvular leak. The authors present a refined technique that has been associated with the most reproducible outcomes.METHODS:
A step-by-step description of the TMVR technique and outcomes of 8 patients treated using this technique are described. Baseline patient clinical and echocardiographic characteristics and 30-day post-TMVR outcomes are presented.RESULTS:
Eight patients underwent transatrial TMVR at a single institution. Five had previous cardiac surgery. Mean STS score was 8%. Technical success by MVARC (Mitral Valve Academic Research Consortium) criteria was 100%. There was zero in-hospital and 30-day mortality. Procedural success by MVARC criteria at 30 days was 100%. Paravalvular leak immediately post-implant was none or trace in 6 and mild in 1.CONCLUSIONS:
The technique described is reproducible and was associated with favorable outcomes in this early experience. It represents a useful technique for the treatment of mitral valve disease in the setting of severe annular calcification. A structured and defined implantation technique is critical to investigators as this field evolves.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Calcinosis
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Prótesis Valvulares Cardíacas
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Implantación de Prótesis de Válvulas Cardíacas
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Válvula Mitral
Límite:
Aged
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Aged80
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Female
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Humans
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Male
Idioma:
En
Año:
2018
Tipo del documento:
Article