Key result
Transcatheter mitral valve-in-valve implantation significantly decreased mean left atrial pressure from 24.3 mmHg to 15.9 mmHg (p<0.001) with 100% procedural success and 0% 30-day mortality.
Why the study?
Does transcatheter mitral valve-in-valve implantation improve acute haemodynamics in high-risk patients with failing mitral xenografts or surgical rings?
Observational (n=12)
Does transcatheter mitral valve-in-valve implantation improve acute haemodynamics in high-risk patients with failing mitral xenografts or surgical rings?
Absolute Event Rate: 15.9% vs 24.3%
p-value: p=<0.001
Transcatheter mitral valve-in-valve or valve-in-ring implantation is feasible and provides significant acute haemodynamic improvement in high-risk patients.
May support acute hemodynamic relief in high-risk mitral reintervention; leaves open durability, selection criteria, and need for prospective data.
AIMS: Transcatheter mitral valve-in-valve implantation (TMViVI) for the treatment of failing mitral xenografts or recurrent mitral regurgitation after surgical ring implantation is an emerging therapy for patients in need of repeated mitral valve surgery. Despite the fact that these procedures have been shown to be feasible and effective, haemodynamic data after TMViVI are still limited in the literature. METHODS AND RESULTS: Twelve patients (logES: 39.2±23.5%) were treated either by transapical (n=7) or transseptal (n=5) TMViVI, as a valve-in-valve (ViV, n=8) or valve-in-ring (ViR, n=4) implantation. Left atrial pressures (LAP), transmitral gradients and right heart haemodynamics (Swan-Ganz catheterisation) were studied before and after TMViVI. Procedural success was 100%, mitral regurgitation after TMViVI was mild in one, trace in five and absent in six patients. Thirty-day mortality was 0%. Left atrial pressures decreased significantly after valve implantation (before LAPmean/v-wave: 24.3/44.1 mmHg; after LAP/v-wave 15.9/22.1 mmHg; p<0.001) and cardiac output increased significantly. Transmitral gradients corresponded to mitral surface areas between 1.7 and 3.5 cm2, and were thus very acceptable in terms of the high surgical risk population. CONCLUSIONS: In conclusion, TMViVI with the balloon-expandable SAPIEN XT valve for ViV or ViR implantation is feasible with promising acute transmitral haemodynamic data. Nevertheless, sustained long-term performance remains to be demonstrated in the future.
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Schäfer et al. (2014) conducted an observational in Failing mitral xenografts or recurrent mitral regurgitation after surgical ring implantation (n=12). Transcatheter mitral valve-in-valve implantation (TMViVI) with SAPIEN XT valve was evaluated on Mean left atrial pressure (LAPmean) (p=<0.001). Transcatheter mitral valve-in-valve implantation significantly decreased mean left atrial pressure from 24.3 mmHg to 15.9 mmHg (p<0.001) with 100% procedural success and 0% 30-day mortality.
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