Key result
Transseptal valve-in-valve TMVR through a prior Cardioform occluder successfully reduces mitral gradient by ~89%.
Why the study?
Transseptal access is critical for TMVR, but prior septal occlusion can complicate reinterventions.
Is transseptal access through a prior atrial septal occluder feasible for valve-in-valve TMVR?
Case Report (n=1)
Is transseptal access through a prior atrial septal occluder feasible for valve-in-valve TMVR?
Transseptal access through a Cardioform Septal Occluder is feasible and safe for valve-in-valve TMVR using electrocautery and balloon dilatation.
Feasible via prior septal occluder in this TMVR case; leaves open safety and reproducibility in larger cohorts.
BACKGROUND: Transseptal access is critical for transcatheter mitral valve replacement (TMVR), but prior septal occlusion can complicate reinterventions. CASE SUMMARY: A 62-year-old woman with dyspnea and severe mitral stenosis of a degenerated M3 bioprosthetic valve underwent valve-in-valve TMVR with access achieved through a previously implanted 30-mm Cardioform Septal Occluder using an electrocauterized wire and Brockenbrough needle, followed by balloon dilatations. A 29-mm SAPIEN 3 valve was implanted, reducing the mitral gradient from 19 to 2 mm Hg. A residual left-to-right shunt was left untreated. The patient was discharged the next day without complications. DISCUSSION: TMVR with a balloon-expandable TAVR platform can be performed safely and effectively through a Cardioform Septal Occluder and is facilitated by predilatation of the Cardioform Septal Occluder with a large balloon. TAKE-HOME MESSAGE: Transseptal access through a Cardioform Septal Occluder is feasible for valve-in-valve TMVR. Awareness of strategies to manage prior interatrial septum closures is crucial as repeat mitral interventions become more common.
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Frisoli et al. (2025) conducted a case report in Severe mitral stenosis of a degenerated bioprosthetic valve with prior septal occlusion (n=1). Valve-in-valve TMVR with transseptal access through a prior Cardioform Septal Occluder was evaluated on Mitral gradient. Valve-in-valve TMVR with transseptal access through a prior Cardioform Septal Occluder successfully reduced the mitral gradient from 19 to 2 mm Hg.
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