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Kushimo OA, Yadav MS, Pandey P, Singh S, Kumar V. Transcatheter aortic valve replacement in patients with a pre-existing prosthetic mitral valve: a single center experience with two cases. Egypt Heart J 2024; 76:3. [PMID: 38190006 PMCID: PMC10774252 DOI: 10.1186/s43044-023-00433-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/24/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND The performance of transcatheter aortic valve replacement (TAVR) in patients with pre-existing prosthetic mitral valves is technically challenging due to the potential interference between both prosthetic devices. At present, there are no clear recommendations for this patient subset due to their exclusion from clinical trials. We report our experience of two cases with pre-existing prosthetic mechanical mitral valves who underwent TAVR. CASE PRESENTATION The first case was a 57 year old man with severe aortic stenosis and type 2 diabetes mellitus who had a mitral valve replacement 32 years ago. Operative mortality risk assessed by the Society for Thoracic Surgery (STS) Score was 1.7%, but he was considered high risk in view of previous cardiac surgery. Pre-procedure CT evaluation revealed favorable aortic root and femoral access anatomy with the mechanical mitral valve located 6.3 mm below the aortic annular plane. He underwent TAVR with a Medtronic Evolut R 29 mm self-expanding transcatheter heart valve via the femoral approach. The second case was a 66 year old lady who presented with severe aortic stenosis, atrial fibrillation and a history of mitral valve replacement 17 years ago for rheumatic mitral stenosis. Her STS score was 3.5%. Pre-procedure CT showed favorable aortic root and femoral access parameters with a mitral-aortic distance of 3.6 mm. TAVR was performed with a balloon expandable Myval 21.5 mm transcatheter heart valve via a transfemoral access. Both procedures were done successfully. CONCLUSION This report highlights the feasibility of TAVR in post-mitral valve replacement patients provided careful pre-procedural evaluation, and planning is done.
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Affiliation(s)
- Oyewole A Kushimo
- Max Institute of Heart and Vascular Sciences, Max Super-Specialty Hospital, Saket, New Delhi, 110017, India.
- Cardiology Unit, Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria.
| | - Mitendra S Yadav
- Max Institute of Heart and Vascular Sciences, Max Super-Specialty Hospital, Saket, New Delhi, 110017, India
| | - Purneshwar Pandey
- Max Institute of Heart and Vascular Sciences, Max Super-Specialty Hospital, Saket, New Delhi, 110017, India
| | - Santosh Singh
- Max Institute of Heart and Vascular Sciences, Max Super-Specialty Hospital, Saket, New Delhi, 110017, India
| | - Viveka Kumar
- Max Institute of Heart and Vascular Sciences, Max Super-Specialty Hospital, Saket, New Delhi, 110017, India
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Kanzaki H, Shimahara Y, Amaki M, Okada A, Fujita T, Izumi C, Yasuda S, Kobayashi J. Transcatheter Aortic Valve Replacement for Aortic Stenosis With Prosthetic Mitral Paravalvular Leak and Hemolytic Anemia. JACC Case Rep 2020; 2:2146-2150. [PMID: 34317126 PMCID: PMC8299977 DOI: 10.1016/j.jaccas.2020.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 11/15/2022]
Abstract
This report describes a successful transcatheter aortic valve replacement in an older patient with severe aortic stenosis, mitral paravalvular leak, and associated hemolytic anemia. Transcatheter aortic valve replacement is worth considering as a first-line procedure in this high-risk patient because of its beneficial impact on reducing shear forces at the mitral valve. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yusuke Shimahara
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Junjiro Kobayashi
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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Transcatheter aortic valve replacement in patients with previous mitral valve replacement. A systematic study. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:177-183. [PMID: 32636902 PMCID: PMC7333196 DOI: 10.5114/aic.2020.96061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/27/2020] [Indexed: 11/17/2022] Open
Abstract
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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Previously implanted mitral surgical prosthesis in patients undergoing transcatheter aortic valve implantation: Procedural outcome and morphologic assessment using multidetector computed tomography. PLoS One 2019; 14:e0226512. [PMID: 31877159 PMCID: PMC6932792 DOI: 10.1371/journal.pone.0226512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/27/2019] [Indexed: 11/19/2022] Open
Abstract
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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Thourani VH, Kelly JJ, Cervantes DG, Vemulapalli S, Manandhar P, Forcillo J, Holmes DR, Cohen DJ, Kirtane AJ, Kodali SK, Leon MB, Babaliaros V, Waksman R, Satler LF, Shults CC, Ben-Dor I, Rogers T, Kapadia S, Reardon MJ, Malaisrie SC, Gleason TG, Holper EM, Bavaria JE, Herrmann HC, Szeto WY, Carroll JD, Mack MJ. Transcatheter Aortic Valve Replacement After Prior Mitral Valve Surgery: Results From the Transcatheter Valve Therapy Registry. Ann Thorac Surg 2019; 109:1789-1796. [PMID: 31655043 DOI: 10.1016/j.athoracsur.2019.08.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 07/25/2019] [Accepted: 08/08/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Due to perceived technical challenges, patients with previous surgical mitral valve repair or replacement (SMVR) have been excluded from most transcatheter aortic valve replacement (TAVR) trials. Our objective was to compare the 30-day and 1-year outcomes of TAVR for patients with and without prior SMVR. METHODS In a retrospective review of The Society of Thoracic Surgeons (STS) and American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry, we compared 1097 patients with prior SMVR to 46,327 patients without prior SMVR who underwent TAVR between November 2011 and September 2015 at 394 US centers. Preoperative characteristics, procedural details, and clinical outcomes were analyzed. RESULTS Patients with previous SMVR were younger, more often female, and had higher STS predicted risk of mortality (8.6% vs 6.8%, P < .001). However, there was no difference in 30-day mortality (4.6% vs 5.5%, P = .293), myocardial infarction, stroke, reintervention, new dialysis, or readmission. Moderate/severe paravalvular leak at discharge was also similar (5.8% vs 4.9%, P = .343). At 1 year, morbidity was similar with slightly higher mortality among patients with prior SMVR (20% vs 17.5%, P = .087) that was significant after adjustment (hazard ratio 1.18, P = .043). The type of prior SMVR (repair, bioprosthetic replacement, or mechanical replacement) had no impact on 30-day or 1-year survival. CONCLUSIONS Patients with prior SMVR undergoing TAVR had similar 30-day outcomes, slightly higher 1-year mortality, and no increase in early paravalvular leak compared with patients who did not have previous SMVR. Prior SMVR should not preclude TAVR for appropriately selected patients.
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Affiliation(s)
- Vinod H Thourani
- Medstar Washington Hospital Center/Georgetown University, Washington, DC.
| | - John J Kelly
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | - David J Cohen
- Harvard Beth Israel Deaconess Hospital, Boston, Massachusetts
| | | | | | | | | | - Ron Waksman
- Medstar Washington Hospital Center/Georgetown University, Washington, DC
| | - Lowell F Satler
- Medstar Washington Hospital Center/Georgetown University, Washington, DC
| | - Christian C Shults
- Medstar Washington Hospital Center/Georgetown University, Washington, DC
| | - Itsik Ben-Dor
- Medstar Washington Hospital Center/Georgetown University, Washington, DC
| | - Toby Rogers
- Medstar Washington Hospital Center/Georgetown University, Washington, DC
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Moris C, Avanzas P. Transcatheter aortic valve implantation and patients excluded from clinical trials: previous mitral valve replacement. J Cardiovasc Med (Hagerstown) 2019; 20:831-832. [PMID: 31592856 DOI: 10.2459/jcm.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- César Moris
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA).,Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Pablo Avanzas
- Área de Gestión Clínica del Corazón, Hospital Universitario Central de Asturias.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA).,Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
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Salaun E, Pibarot P. Transcatheter Aortic Valve Implantation After Mitral Valve Replacement: Insights From the OPTIMAL Registry. Can J Cardiol 2019; 35:805-808. [PMID: 31292075 DOI: 10.1016/j.cjca.2019.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Erwan Salaun
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada.
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Squiers JJ, Potluri S, Brinkman WT, DiMaio JM. Systematic review of transcatheter aortic valve replacement after previous mitral valve surgery. J Thorac Cardiovasc Surg 2018; 155:63-65.e5. [DOI: 10.1016/j.jtcvs.2017.08.129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/11/2017] [Accepted: 08/24/2017] [Indexed: 11/24/2022]
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Greason KL, Sandhu GS, Nkomo VT, King KS, Joyce DL, Williamson EE, Holmes DR. Transcatheter aortic valve insertion after previous mitral valve operation. J Thorac Cardiovasc Surg 2017; 154:810-815. [DOI: 10.1016/j.jtcvs.2017.03.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 02/11/2017] [Accepted: 03/15/2017] [Indexed: 11/26/2022]
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