Transcatheter mitral valve-in-ring implantation in high-risk patients with failed surgical annuloplasty achieved an 88% procedural success rate and 82% 30-day survival.
Observational (n=17)
Does transcatheter mitral valve-in-ring implantation (TVIR) improve clinical and haemodynamic outcomes in high-risk patients with failure of surgical mitral ring annuloplasty?
Transcatheter mitral valve-in-ring implantation is a feasible alternative that provides short-term clinical and haemodynamic improvement for high-risk patients with failed surgical mitral ring annuloplasty.
OBJECTIVES: Redo surgery after failed mitral valve repair may be high risk, or contraindicated in patients with comorbidities. Because of this high risk, other interventional possibilities like transcatheter valve implantation might be of benefit. We report our experience with transcatheter mitral valve-in-ring implantation (TVIR) in high-risk patients after failure of surgical ring annuloplasty. METHODS: From January 2010 to February 2012, following a multidisciplinary discussion, 17 high-risk patients underwent TVIR using Edwards SAPIEN XT prostheses, via either a transvenous transseptal (n = 8), or a transapical approach (n = 9). RESULTS: Patients were aged 70 ± 16 years, in New York Association classes III/IV. Their mean logistic EuroSCORE was 36 ± 17% and mean Society of Thoracic Surgeons risk score 13 ± 9%. The mean time interval between surgery and repair failure was 7 ± 3 years. Annuloplasty rings were semi-rigid in 14 cases, flexible in 2, and rigid in 1. Manufacturers ring diameters were 26 mm in 4 patients, 27 mm in 1, 28 mm in 9, 30 mm, 31 mm and 34 mm in 1. The predominant failure mode was regurgitation in 12 cases and stenosis in 5. SAPIEN XT diameters were 26 mm in 15 patients, 23 mm and 29 mm in 1. Procedural success rate was 88% (15/17). Emergency surgery was needed in 1 patient due to acute dislodgement of the ring. The degree of mitral regurgitation was reduced to none or mild in all but 2 patients; final mean gradient was 7 ± 3 mmHg. Thirty-day survival was 82% (14/17 patients). At last follow-up (13 ± 5 months), survival rate was 71% (12/17). CONCLUSIONS: These preliminary results suggest that TVIR is feasible, with low operative risk, and may provide short-term clinical and haemodynamic improvement in selected high-risk patients with failure of mitral ring annuloplasty.
Descoutures et al. (2013) conducted an observational in Failure of surgical mitral repair (n=17). Transcatheter mitral valve-in-ring implantation (TVIR) was evaluated on Procedural success. Transcatheter mitral valve-in-ring implantation in high-risk patients with failed surgical annuloplasty achieved an 88% procedural success rate and 82% 30-day survival.