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Awtry JA, Shi WY, McGurk S, Louis C, Ailawadi G, George I, Smith RL, Sabe AA, Kaneko T. National trends in utilization of transatrial transcatheter mitral valve replacement and postoperative outcomes. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00966-2. [PMID: 37839658 DOI: 10.1016/j.jtcvs.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/09/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE Transatrial transcatheter mitral valve replacement reduces complexity during mitral valve replacements involving high-risk patients with mitral annular calcification. This study examines trends in transatrial transcatheter mitral valve replacement use and outcomes. METHODS Patients in the Society of Thoracic Surgeons database from 2014 to 2021 with mitral annular calcification undergoing transatrial transcatheter mitral valve replacement were included. Exclusion criteria were hypertrophic cardiomyopathy, congenital mitral valve disease, ventricular assist device placement, or prior mitral valve surgery. Primary outcomes were operative mortality and major adverse cardiac events compared between the Early (2014-2017, N = 71) and Recent (2018-2021, N = 151) eras. Parsimonious multivariable regression assessed select possible confounders for trends in major adverse cardiac events. RESULTS Overall, 222 transatrial transcatheter mitral valve replacements at 104 hospitals were identified. Annual volume increased from 6 in 2014 to 43 in 2021. Median hospital volume was 1, maximum hospital volume was 17, and 10 or more replacements were performed at 4 hospitals. Mortality and major adverse cardiac events occurred in 10.4% and 22.5% of patients, respectively. Compared with the Early era patients, Recent era patients were more often elective (79.5% vs 64.8%) and were approached via sternotomy (90.1% vs 80.3%, all P < .05). Despite similar predicted risk of mortality (9.6% ± 11.1% vs 11.0% ± 6.0%; P = .61), Recent patients had reduced mortality (3.3% vs 25.4%, P < .001) and major adverse cardiac events (18.5% vs 31.0%; P = .057). On univariate and multivariable analyses, the Recent surgical era was significantly associated with lower mortality (0.10 [0.04-0.29]; P < .001) and lower major adverse cardiac events (0.48 [0.25-0.94]; P = .032), respectively. There were no preoperative characteristics that were significant confounders for the difference in major adverse cardiac events. CONCLUSIONS Mortality and major adverse cardiac events after transatrial transcatheter mitral valve replacement have decreased significantly in the contemporary era independent of changes in major patient and operative characteristics. Transatrial transcatheter mitral valve replacement will have a future role in patients with mitral annular calcification.
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Affiliation(s)
- Jake A Awtry
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - William Y Shi
- Division of Cardiovascular and Thoracic Surgery, Northwell Health System, New York, NY
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Clauden Louis
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Gorav Ailawadi
- Division of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Isaac George
- Division of Cardiac Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY
| | - Robert L Smith
- Department of Cardiothoracic Surgery, Baylor Scott and White, The Heart Hospital, Plano, Tex
| | - Ashraf A Sabe
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass.
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University in St Louis/Barnes-Jewish Hospital, St Louis, Mo
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Bagaev E, Ali A, Saha S, Sadoni S, Orban M, Naebauer M, Mehilli J, Massberg S, Oberbach A, Hagl C. Hybrid Surgery for Severe Mitral Valve Calcification: Limitations and Caveats for an Open Transcatheter Approach. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010093. [PMID: 35056401 PMCID: PMC8777627 DOI: 10.3390/medicina58010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Mitral stenosis with extensive mitral annular calcification (MAC) remains surgically challenging in respect to clinical outcome. Prolonged surgery time with imminent ventricular rupture and systolic anterior motion can be considered as a complex of causal factors. The aim of our alternative hybrid approach was to reduce the risk of annual rupture and paravalvular leaks and to avoid obstruction of the outflow tract. A review of the current literature was also carried out. Materials and Methods: Six female patients (mean age 76 ± 9 years) with severe mitral valve stenosis and severely calcified annulus underwent an open implantation of an Edwards Sapien 3 prosthesis on cardiopulmonary bypass. Our hybrid approach involved resection of the anterior mitral leaflet, placement of anchor sutures and the deployment of a balloon expanded prosthesis under visual control. Concomitant procedures were carried out in three patients. Results: The mean duration of cross-clamping was 95 ± 31 min and cardiopulmonary bypass was 137 ± 60 min. The perioperative TEE showed in three patients an inconspicuous, heart valve-typical gradient on all implanted prostheses and a clinically irrelevant paravalvular leakage occurred in the anterior annulus. In the left ventricular outflow tract, mild to moderately elevated gradients were recorded. No adverse cerebrovascular events and pacemaker implantations were observed. All but one patient survived to discharge. Survival at one year was 83.3%. Conclusions: This “off label” implantation of the Edwards Sapien 3 prosthesis may be considered as a suitable bail-out approach for patients at high-risk for mitral valve surgery or deemed inoperable due to extensive MAC.
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Affiliation(s)
- Erik Bagaev
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, 90471 Nuremberg, Germany
| | - Ahmad Ali
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
| | - Shekhar Saha
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
- Correspondence:
| | - Sebastian Sadoni
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
| | - Martin Orban
- German Centre for Cardiovascular Research (DZHK), Department of Cardiology, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (M.O.); (M.N.); (J.M.); (S.M.)
| | - Michael Naebauer
- German Centre for Cardiovascular Research (DZHK), Department of Cardiology, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (M.O.); (M.N.); (J.M.); (S.M.)
| | - Julinda Mehilli
- German Centre for Cardiovascular Research (DZHK), Department of Cardiology, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (M.O.); (M.N.); (J.M.); (S.M.)
- Medizinische Klinik I, Landshut-Achdorf Hospital, 84036 Landshut, Germany
| | - Steffen Massberg
- German Centre for Cardiovascular Research (DZHK), Department of Cardiology, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (M.O.); (M.N.); (J.M.); (S.M.)
| | - Andreas Oberbach
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
| | - Christian Hagl
- German Centre for Cardiovascular Research (DZHK), Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, 80539 Munich, Germany; (E.B.); (A.A.); (S.S.); (A.O.); (C.H.)
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Kawano Y, Newell P, Harloff M, Hirji S, Percy E, Shah P, Kaneko T. Early outcomes of transatrial mitral valve replacement in severe mitral annular calcification. JTCVS Tech 2021; 9:49-56. [PMID: 34647059 PMCID: PMC8501192 DOI: 10.1016/j.xjtc.2021.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/07/2021] [Indexed: 11/26/2022] Open
Abstract
Objective Mitral valve replacement (MVR) in the setting of severe mitral annular calcification is a technically challenging operation with increased morbidity and mortality. Transseptal/apical transcatheter MVR (TMVR) in mitral annular calcification has emerged as an option for these cases, although may not be feasible due to anatomical reasons. Transatrial TMVR is a potential treatment option for this subgroup of patients. Methods Patients who underwent transatrial TMVR between June 2018 and November 2020 at a single institution were included. Patients were selected by a structural heart team based on their surgical risk, pattern of mitral annular calcification, risk of valve migration, left ventricular outflow obstruction, and paravalvular leak. Results A total of 11 patients underwent transatrial TMVR. Mean patient age was 74.2 years and mean Society of Thoracic Surgeons predicted risk of mortality score was 9.1%. All patients had the presence of both mitral stenosis and regurgitation—dominant etiology—was mitral stenosis in 81.2%, and mitral regurgitation in 18.8%. Among patients, 54.5% had a concomitant cardiac procedure. There was no in-hospital or 30-day mortality. Technical success defined by the Mitral Valve Academic Research Consortium was achieved in 90.9% of patients. Postoperative paravalvular leak was mild or less in all patients. Conclusions In this series, transatrial TMVR was shown to be a safe and effective treatment option for patients who are high risk for surgical MVR and should be in surgeons' armamentarium in the treatment of this high-risk patient population. Dissemination of safe technique will be critical in the successful conduct of this surgery.
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Affiliation(s)
- Yuji Kawano
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.,Division of Cardiac Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Paige Newell
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Morgan Harloff
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Edward Percy
- Division of Cardiac Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pinak Shah
- Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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4
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Abstract
Transcatheter mitral valve (MV) repair, specifically the edge-to-edge leaflet repair, is a less invasive treatment of symptomatic mitral regurgitation (MR) in patients with high or prohibitive surgical risk. In cases with severe leaflet calcification, small mitral orifice area, and/or extremely wide regurgitation across the entire MV commissure, transcatheter MV repair may rather cause suboptimal or potentially hazardous outcomes. In these cases, MV replacement can be a more suitable option. Recently, percutaneous transcatheter MV replacement has emerged as an acceptable therapeutic option for the treatment of degenerated surgical bioprosthetic disease. Moreover, several transcatheter devices for native MV replacement are under evaluation with a hope to provide more complete and reproducible restoration of MV function. In this article, we will review current status, applications, clinical outcomes, and limitations that need to be overcome for transcatheter MV replacement for both degenerated surgical bioprosthetic disease and native MV disorders.
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Affiliation(s)
- Yusuke Enta
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Mamoo Nakamura
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.
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Codecasa R, De Cillis P, Stefàno P. Balloon-expandable prosthesis for open mitral replacement with a calcified mitral annulus. JTCVS Tech 2020; 5:25-26. [PMID: 34318099 PMCID: PMC8299984 DOI: 10.1016/j.xjtc.2020.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Riccardo Codecasa
- Unit of Cardiac Surgery, Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy
| | - Paolo De Cillis
- Unit of Cardiac Surgery, Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy
| | - Pierluigi Stefàno
- Unit of Cardiac Surgery, Cardiothoracic and Vascular Department, Careggi University Hospital, Florence, Italy
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6
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Commentary: Hybrid valve-in-valve transcatheter mitral valve replacement: You can never have too many tools in your toolbox. JTCVS Tech 2020; 3:160-161. [PMID: 34317854 PMCID: PMC8303087 DOI: 10.1016/j.xjtc.2020.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/08/2020] [Accepted: 05/21/2020] [Indexed: 11/30/2022] Open
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Albacker TB, Bakir B, Eldemerdash A, Elshaer F, Albacker H, Alawami M, Kashour T. Surgical mitral valve replacement using direct implantation of Sapien 3 valve in a patients with severe mitral annular calcification without adjunctive techniques, a case report. J Cardiothorac Surg 2020; 15:42. [PMID: 32093723 PMCID: PMC7041179 DOI: 10.1186/s13019-020-1083-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/17/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Mitral annular calcification (MAC) occurs represents a challenge to surgeons during mitral valve (MV) surgery with increased perioperative risk. CASE PRESENTATION We describe a challenging case of an elderly female patient with multiple comorbidities who presented with symptoms and signs of heart failure with a previous history of mechanical aortic valve replacement 15 years prior to presentation. Echocardiogram showed severe mitral stenosis and regurgitation with severe calcification of the mitral annulus. Given her high-risk profile and unavailability of suitable percutaneous therapeutic options we decided to replace her mitral valve with Sapien 3 valve under direct exposure. The case describes the technical details for the valve implantation and demonstrates the viability of this option in high risk surgical patients without the need for adjunct techniques like predilatation, additional supporting sutures or patches with a review of the literature on open surgical implantation of Sapien 3 valve. CONCLUSION Direct open surgical implantation of Sapien 3 valve can be implanted safely in patients with severe MAC, without predilatation and without the use of other adjunctive techniques like fixation sutures or patches.
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Affiliation(s)
- Turki B Albacker
- Cardiac Sciences Department, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Bakir Bakir
- Cardiac Sciences Department, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Eldemerdash
- Cardiac Sciences Department, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fayez Elshaer
- Cardiac Sciences Department, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hanan Albacker
- Cardiac Sciences Department, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Murtadha Alawami
- Cardiac Sciences Department, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Tariq Kashour
- Cardiac Sciences Department, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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8
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Russell HM, Guerrero ME, Salinger MH, Manzuk MA, Pursnani AK, Wang D, Nemeh H, Sakhuja R, Melnitchouk S, Pershad A, Fang HK, Said SM, Kauten J, Tang GHL, Aldea G, Feldman TE, Bapat VN, George IM. Open Atrial Transcatheter Mitral Valve Replacement in Patients With Mitral Annular Calcification. J Am Coll Cardiol 2019; 72:1437-1448. [PMID: 30236304 DOI: 10.1016/j.jacc.2018.07.033] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/02/2018] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Hyde M Russell
- Division of Cardiovascular Surgery, NorthShore University HealthSystem, Evanston, Illinois.
| | - Mayra E Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota
| | - Michael H Salinger
- Division of Cardiology and Cardiovascular Surgery, Froedtert/Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Melissa A Manzuk
- Division of Cardiovascular Surgery, NorthShore University HealthSystem, Evanston, Illinois
| | - Amit K Pursnani
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois
| | - Dee Wang
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan
| | - Hassan Nemeh
- Center for Structural Heart Disease, Henry Ford Hospital, Detroit, Michigan
| | - Rahul Sakhuja
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Ashish Pershad
- Banner-University Medicine Heart Institute, Phoenix, Arizona
| | - H Kenith Fang
- Banner-University Medicine Heart Institute, Phoenix, Arizona
| | - Sameh M Said
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - James Kauten
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, New York
| | - Gabriel Aldea
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
| | - Ted E Feldman
- Division of Cardiology, NorthShore University HealthSystem, Evanston, Illinois
| | - Vinnie N Bapat
- Division of Vascular, Thoracic and Cardiac Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
| | - Isaac M George
- Division of Vascular, Thoracic and Cardiac Surgery, New York Presbyterian Hospital-Columbia University Medical Center, New York, New York
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Bertrand PB, Mihos CG, Yucel E. Mitral Annular Calcification and Calcific Mitral Stenosis: Therapeutic Challenges and Considerations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:19. [PMID: 30929092 DOI: 10.1007/s11936-019-0723-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Mitral annular calcification (MAC) and associated calcific mitral stenosis (MS) are frequent in the aging population, although optimal management remains debated and outcomes are poor. This article summarizes challenges in the diagnosis and therapy of calcific MS, the indications for valve intervention, procedural concerns, and emerging treatment options. RECENT FINDINGS Surgical mitral valve replacement is the procedure of choice in symptomatic patients at acceptable surgical risk, with transcatheter mitral valve replacement (TMVR) being evaluated in clinical trials as an alternative for patients at prohibitive surgical risk. Significant challenges exist with the currently available technology and outcomes have been suboptimal. Optimizing the patient-selection process by using multimodality imaging tools has proven to be essential. MAC and calcific MS is an increasingly prevalent, challenging issue with poor outcomes. While surgical valve replacement can be performed in patients with acceptable surgical risk, TMVR can be considered for patients at higher risk. Clinical trials are underway to optimize outcomes. Dedicated device designs and techniques to minimize risk of left ventricular outflow tract obstruction, paravalvular leakage, and device embolization are to be awaited.
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Affiliation(s)
- Philippe B Bertrand
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA, 02114, USA
| | - Christos G Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA, 02114, USA.
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10
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Open atrial transcatheter mitral valve replacement in patients with mitral annular calcification. J Thorac Cardiovasc Surg 2019; 157:907-916. [DOI: 10.1016/j.jtcvs.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/02/2018] [Indexed: 11/15/2022]
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11
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Jeganathan R, Imran Hamid U, Johnston N, Owens C, Spence M, Manoharan G, Nzewi O. The role of surgical transcatheter valve implantation for the treatment of severe mitral annular calcification. J Card Surg 2019; 34:161-166. [DOI: 10.1111/jocs.14004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/15/2019] [Accepted: 02/06/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Reuben Jeganathan
- Department of Cardiothoracic SurgeryRoyal Victoria HospitalBelfast United Kingdom
| | - Umar Imran Hamid
- Department of Cardiothoracic SurgeryRoyal Victoria HospitalBelfast United Kingdom
| | - Nicola Johnston
- Department of CardiologyRoyal Victoria HospitalBelfast United Kingdom
| | - Colum Owens
- Department of CardiologyRoyal Victoria HospitalBelfast United Kingdom
| | - Mark Spence
- Department of CardiologyRoyal Victoria HospitalBelfast United Kingdom
| | - Ganesh Manoharan
- Department of CardiologyRoyal Victoria HospitalBelfast United Kingdom
| | - Onyekwelu Nzewi
- Department of Cardiothoracic SurgeryRoyal Victoria HospitalBelfast United Kingdom
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12
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Transatrial implantation of a transcatheter heart valve for severe mitral annular calcification. J Thorac Cardiovasc Surg 2018; 156:132-142. [DOI: 10.1016/j.jtcvs.2018.03.016] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/09/2018] [Accepted: 03/06/2018] [Indexed: 11/18/2022]
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13
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Hybrid Open Minimally Invasive Transcatheter Mitral Valve Replacement. Ann Thorac Surg 2018; 106:e57-e59. [PMID: 29605597 DOI: 10.1016/j.athoracsur.2018.02.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/02/2018] [Accepted: 02/21/2018] [Indexed: 11/23/2022]
Abstract
We describe a hybrid surgical interventional technique for minimally invasive implantation of a transcatheter aortic valve in the mitral position. This technique does not require circular mitral annular calcification and minimizes the risk of left ventricular outflow tract obstruction. We believe this technique represents a useful approach for surgeons and interventional cardiologists until specialized transcatheter mitral valve devices become available.
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Role of Echocardiography in Transcatheter Mitral Valve Replacement in Native Mitral Valves and Mitral Rings. J Am Soc Echocardiogr 2018; 31:475-490. [DOI: 10.1016/j.echo.2018.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Indexed: 02/06/2023]
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15
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Hamdeh YM, Goldhammer JE, Ruggiero NJ, Entwistle JW. Ventricular Perforation During Open Surgical Balloon Expandable Mitral Valve Replacement: A Case Report. ACTA ACUST UNITED AC 2018; 9:300-304. [PMID: 28697033 DOI: 10.1213/xaa.0000000000000599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 79-year-old woman with severe mitral annular calcification was scheduled for mitral valve replacement. A SAPIEN 3 valve was implanted in mitral position using an open surgical approach. Immediately after cardiopulmonary bypass, bleeding from an unidentified source was encountered. Cardiopulmonary bypass was emergently resumed and a laceration of the left ventricular apex due to the valve delivery system was detected. Risk factors specific to the open surgical approach include a decompressed ventricle, decreased annulus to apical distance, and the absence of continuous fluoroscopic and echocardiographic imaging. These create a clinical scenario where risk of ventricular perforation is increased compared with traditional intravascular transcatheter valve delivery.
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Affiliation(s)
- Yousef M Hamdeh
- From the Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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Ghosh-Dastidar M, Bapat V. Transcatheter Valve Implantation in Mitral Annular Calcification During Open Surgery: Extended Collar Technique. Ann Thorac Surg 2017; 104:e303-e305. [DOI: 10.1016/j.athoracsur.2017.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 04/30/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
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El Sabbagh A, Eleid MF, Foley TA, Al-Hijji MA, Daly RC, Rihal CS, Said SM. Direct transatrial implantation of balloon-expandable valve for mitral stenosis with severe annular calcifications: early experience and lessons learned†. Eur J Cardiothorac Surg 2017; 53:162-169. [DOI: 10.1093/ejcts/ezx262] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/14/2017] [Indexed: 11/13/2022] Open
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18
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Babaliaros VC, Greenbaum AB, Khan JM, Rogers T, Wang DD, Eng MH, O'Neill WW, Paone G, Thourani VH, Lerakis S, Kim DW, Chen MY, Lederman RJ. Intentional Percutaneous Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction During Transcatheter Mitral Valve Replacement: First-in-Human Experience. JACC Cardiovasc Interv 2017; 10:798-809. [PMID: 28427597 PMCID: PMC5579329 DOI: 10.1016/j.jcin.2017.01.035] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study sought to use a new catheter technique to split the anterior mitral valve leaflet (AML) and prevent iatrogenic left ventricular outflow tract (LVOT) obstruction immediately before transcatheter mitral valve replacement (TMVR). BACKGROUND LVOT obstruction is a life-threatening complication of TMVR, caused by septal displacement of the AML. METHODS The procedure was used in patients with severe mitral valve disease and prohibitive surgical risk. Patients either had prior surgical mitral valve ring (n = 3) or band annuloplasty (n = 1) or mitral annular calcification with stenosis (n = 1). Iatrogenic LVOT obstruction or transcatheter heart valve dysfunction was predicted in all based on echocardiography and computed tomography. Transfemoral coronary guiding catheters directed an electrified guidewire across the center and base of the AML toward a snare in the left atrium. The externalized guidewire loop was then electrified to lacerate the AML along the centerline from base to tip, sparing chordae, immediately before transseptal TMVR. RESULTS Five patients with prohibitive risk of LVOT obstruction or transcatheter heart valve dysfunction from TMVR successfully underwent LAMPOON, with longitudinal splitting of the A2 scallop of the AML, before valve implantation. Multiplane computed tomography modeling predicted hemodynamic collapse from TMVR assuming an intact AML. However, critical LVOT gradients were not seen following LAMPOON and TMVR. Doppler blood flow was seen across transcatheter heart valve struts that encroached the LVOT, because the AML was split. Transcatheter heart valve function was unimpeded. CONCLUSIONS This novel catheter technique, which resembles surgical chord-sparing AML resection, may enable TMVR in patients with prohibitive risk of LVOT obstruction or transcatheter heart valve dysfunction.
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Affiliation(s)
| | - Adam B Greenbaum
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
| | - Jaffar M Khan
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Toby Rogers
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Dee Dee Wang
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
| | - Marvin H Eng
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
| | - William W O'Neill
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
| | - Gaetano Paone
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan
| | - Vinod H Thourani
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | - Stamatios Lerakis
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | - Dennis W Kim
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia; Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Marcus Y Chen
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Robert J Lederman
- Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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Polomsky M, Koulogiannis KP, Kipperman RM, Cohen BM, Magovern CJ, Slater JP, Xydas S, Marcoff L, Brown JM. Mitral Valve Replacement With Sapien 3 Transcatheter Valve in Severe Mitral Annular Calcification. Ann Thorac Surg 2017; 103:e57-e59. [DOI: 10.1016/j.athoracsur.2016.06.105] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/02/2016] [Accepted: 06/22/2016] [Indexed: 11/29/2022]
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20
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Implantation of Transcatheter Aortic Prosthesis in 3 Patients With Mitral Annular Calcification. Ann Thorac Surg 2016; 102:e433-e435. [DOI: 10.1016/j.athoracsur.2016.03.097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 03/24/2016] [Accepted: 03/30/2016] [Indexed: 11/22/2022]
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21
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Eleid MF, Foley TA, Said SM, Pislaru SV, Rihal CS. Severe Mitral Annular Calcification. JACC Cardiovasc Imaging 2016; 9:1318-1337. [DOI: 10.1016/j.jcmg.2016.09.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 11/30/2022]
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22
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Gualis J, Estévez-Loureiro R, Alonso D, Martínez-Comendador JM, Martín E, Castaño M. Insertion of an Edwards Sapien 3 prosthesis as a mitral valve in valve implantation via a transapical approach. J Card Surg 2016; 31:575-7. [DOI: 10.1111/jocs.12801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Javier Gualis
- Deparment of Cardiac Surgery; Complejo Asistencial Universitario de León; León Spain
| | - Rodrigo Estévez-Loureiro
- Department of Cardiology, Interventional Cardiology; Complejo Asistencial Universitario de León; León Spain
| | - David Alonso
- Department of Cardiology, Interventional Cardiology; Complejo Asistencial Universitario de León; León Spain
| | | | - Elio Martín
- Deparment of Cardiac Surgery; Complejo Asistencial Universitario de León; León Spain
| | - Mario Castaño
- Deparment of Cardiac Surgery; Complejo Asistencial Universitario de León; León Spain
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