Key result
Transapical TMVR with the Tiara valve in high-risk patients with severe MR and previous aortic valve replacement achieved 100% procedural success with no major complications at 30 days.
Why the study?
Is transapical TMVR with the Tiara valve safe and feasible in high-risk patients with severe MR and previous aortic valve replacement?
Observational (n=12)
Is transapical TMVR with the Tiara valve safe and feasible in high-risk patients with severe MR and previous aortic valve replacement?
Transapical TMVR with the Tiara valve is technically feasible and safe in high-risk patients with severe MR and preexisting aortic valve prostheses, a population traditionally excluded from TMVR trials.
Should not yet alter practice for severe MR after aortic valve replacement; leaves open prospective evaluation of transapical TMVR.
BACKGROUND: Transcatheter mitral valve replacement (TMVR) may mature to become a therapeutic option for high-risk patients with severe mitral regurgitation (MR), particularly in patients at high or prohibitive surgical risk. MR patients with preexisting aortic valve prosthesis have been excluded from most TMVR trials because of the potential risks of left ventricular outflow tract obstruction or interaction between the TMVR anchoring mechanism and the aortic prosthesis. We describe the procedural and short-term outcomes of transapical TMVR with the Tiara valve in patients experiencing severe symptomatic MR with previous aortic valve replacement (AVR). METHODS AND RESULTS: Twelve consecutive high surgical risk patients (11 men; mean age, 75±6 years) with aortic valve prosthesis and severe MR underwent TMVR with Tiara valve. Aortic valves were mechanical in 5 and biological in 7 patients, while 1 patient had previously undergone implantation of a transcatheter valve within a failed bioprosthetic surgical valve. Six patients (50%) had undergone redo surgical aortic valve replacement. Clinical characteristics of the group include prior mitral valve repair in 2, prior coronary bypass grafting surgery in 5, chronic atrial fibrillation in 7, renal failure in 9, and pacemaker/cardiac resynchronization device in 9 patients. Mean Society of Thoracic Surgery score and EuroSCORE II were 10.5±4.4 and 12.4±3.7, respectively. Mean baseline left ventricular ejection fraction was 35.5±5.3% (range, 30%-45%). The Tiara valve was implanted uneventfully in all patients. Device migration or left ventricular outflow tract obstruction was not observed. No patient required conversion to open heart surgery or periprocedural hemodynamic support. Procedural success was 100% with no death, MI, stroke, major bleeding, or access site complications at 30 days. MR was eliminated in all 12 patients immediately after implantation. CONCLUSIONS: Transapical mitral valve replacement with the Tiara valve in high-risk patients with severe MR and aortic valve prostheses is technically feasible and can be performed safely.
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Cheung et al. (2018) conducted an observational in severe symptomatic mitral regurgitation with previous aortic valve replacement (n=12). Transapical TMVR with the Tiara valve was evaluated on Procedural success. Transapical TMVR with the Tiara valve in high-risk patients with severe MR and previous aortic valve replacement achieved 100% procedural success with no major complications at 30 days.
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