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Schamroth Pravda N, Mishaev R, Levi A, Witberg G, Shapira Y, Orvin K, Barkan YT, Hamdan A, Sharoni R, Perl L, Sagie A, Assa HV, Kornowski R, Codner P. Five-Year Outcomes of Patients With Mitral Structural Valve Deterioration Treated With Transcatheter Valve in Valve Implantation – A Single Center Prospective Registry. Front Cardiovasc Med 2022; 9:883242. [PMID: 35557522 PMCID: PMC9086553 DOI: 10.3389/fcvm.2022.883242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022] Open
Abstract
The Valve-in-Valve (ViV) technique is an emerging alternative for the treatment of bioprosthetic structural valve deterioration (SVD) in the mitral position. We report on intermediate-term outcomes of patients with symptomatic SVD in the mitral position who were treated by transcatheter mitral valve-in-valve (TM-ViV) implantation during the years 2010–2019 in our center. Three main outcomes were examined during the follow-up period: NYHA functional class, TM-ViV hemodynamic data per echocardiography, and mortality. Our cohort consisted of 49 patients (mean age 77.4 ± 10.5 years, 65.3% female). The indications for TM-ViV were mainly for regurgitant pathology (77.6%). All 49 patients were treated with a balloon-expandable device. The procedure was performed via transapical access in 17 cases (34.7%) and transfemoral vein/trans-atrial septal puncture in 32 cases (65.3%). Mean follow-up was 4.4 ± 2.0 years. 98% and 91% of patients were in NYHA I/II at 1 and 5 years, respectively. Mitral regurgitation was ≥moderate in 86.3% of patients prior to the procedure and this decreased to 0% (p < 0.001) following the procedure and was maintained over 2 years follow-up. The mean trans-mitral valve gradients decreased from pre-procedural values of 10.1 ± 5.1 mmHg to 7.0 ± 2.4 mmHg at 1 month following the procedure (p = 0.03). Mortality at 1 year was 16% (95%, CI 5–26) and 35% (95%, CI 18–49) at 5 years. ViV in the mitral position offers an effective and durable treatment option for patients with SVD at high surgical risk.
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Affiliation(s)
- Nili Schamroth Pravda
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel associated with Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Nili Schamroth Pravda,
| | - Raffael Mishaev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel associated with Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel associated with Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Shapira
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel associated with Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katia Orvin
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel associated with Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yeela Talmor Barkan
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel associated with Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel associated with Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Sharoni
- Cardio-Thoracic Surgery Department, Faculty of Medicine, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel associated with Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Sagie
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel associated with Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin Assa
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel associated with Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel associated with Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel associated with Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Al Nasef M, Alsahari A, Eltayeb A, Ahmad S, Al Khalaf K, Al Otaiby M, Al Moghairi A, Al Khushail A, Al Amri H, Elmandouh D, Momenah T. Transcatheter Mitral Valve-in-Valve Implantation in Pediatric Patients. CJC Open 2022; 4:20-27. [PMID: 35072024 PMCID: PMC8767141 DOI: 10.1016/j.cjco.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Transcatheter implantation of the Edwards Sapien 3 valve (Edwards Lifesciences, Irvine CA) within the bioprosthetic mitral valve (MV) is an established method of treatment in adults. However, it has not been well studied in the pediatric age group. METHODS Transcatheter mitral valve-in-valve implantation was attempted in 4 symptomatic pediatric patients with a dysfunctional MV bioprosthesis implanted at an earlier stage due to severe MV stenosis or regurgitation. We reviewed our experience with MV implantation in this cohort. RESULTS The mean age and weight of the patients at the time of the procedure were 11.4 years (range: 10-14 years) and 36 kg (range: 31-44 kg), respectively. The transmitral mean gradient dropped from a mean of 19.75 mm Hg (range: 15-22 mm Hg) to a mean of 1 mm Hg (range: 0-3 mm Hg) after the procedure. The mean fluoroscopy time was 55.25 minutes (range: 40-72 minutes), and the mean hospital length of stay was 4 days (range: 3-7 days). The patients' functional class improved from New York Heart Association class IV to class I during the follow-up period. CONCLUSIONS Transcatheter mitral valve-in-valve implantation can be performed safely for dysfunctional bioprosthetic MVs in the pediatric age group with favorable early and midterm outcomes. This procedure offers a viable alternative in patients who have high surgical risk or are deemed unfit for conventional surgery. However, we still recommend a long-term study of this approach in a large cohort, multicentre study.
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Affiliation(s)
- Mohamed Al Nasef
- Pediatric Cardiology Department, Prince Sultan Cardiac Centre, Riyadh, Kingdom of Saudi Arabia
| | - Atif Alsahari
- Pediatric Cardiology Department, Prince Sultan Cardiac Centre, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Eltayeb
- Pediatric Cardiology Department, Prince Sultan Cardiac Centre, Riyadh, Kingdom of Saudi Arabia
| | - Salim Ahmad
- Pediatric Cardiology Department, Prince Sultan Cardiac Centre, Riyadh, Kingdom of Saudi Arabia
| | - Khalaf Al Khalaf
- Pediatric Cardiology Department, Prince Sultan Cardiac Centre, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Al Otaiby
- Adult Cardiology Department, Prince Sultan Cardiac Centre, Riyadh, Kingdom of Saudi Arabia
| | | | - Abdullah Al Khushail
- Adult Cardiology Department, Prince Sultan Cardiac Centre, Riyadh, Kingdom of Saudi Arabia
| | - Hussein Al Amri
- Adult Cardiology Department, Prince Sultan Cardiac Centre, Riyadh, Kingdom of Saudi Arabia
| | - Doaa Elmandouh
- High Institute of Public Health, University of Alexandria, Alexandria, Egypt
| | - Tarek Momenah
- Pediatric Cardiology Department, Prince Sultan Cardiac Centre, Riyadh, Kingdom of Saudi Arabia
- College of Medicine, Al Faisal University, Riyadh, Kingdom of Saudi Arabia
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Ghalyoun BA, Shah D, Vasudev R, Shamoon D, Shamoon F. Tragic End or Expected Destiny?: Pulmonary Edema Due to Sewing Ring Dehiscence of Bioprosthetic Mitral Valve. JACC Case Rep 2019; 1:865-868. [PMID: 34316947 PMCID: PMC8288797 DOI: 10.1016/j.jaccas.2019.11.027] [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: 10/01/2019] [Revised: 11/05/2019] [Accepted: 11/05/2019] [Indexed: 11/05/2022]
Abstract
The present case is unique because it describes transcatheter mitral valve replacement with a valve-in-valve procedure in an emergent setting of pulmonary edema and cardiogenic shock. Although transcatheter mitral valve replacement is in its initial phase, it remains a viable option in an emergency. Further research is needed to evaluate the short term and long-term outcomes. (Level of Difficulty: Beginner.)
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Affiliation(s)
- Bader Abu Ghalyoun
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, New Jersey
| | - Dhaval Shah
- Department of Medicine, Trinitas Regional Medical Center, Elizabeth, New Jersey
| | - Rahul Vasudev
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, New Jersey
| | - Dema Shamoon
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, New Jersey
| | - Fayez Shamoon
- Department of Cardiology, St. Joseph's University Medical Center, Paterson, New Jersey
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