Safety of Transcatheter Aortic Valve Replacement in Patients with Prosthetic Mitral Valve

Transcatheter aortic valve replacement (TAVR) has become an alternative procedure for treating aortic stenosis in patients with advanced age and comorbidities. Although patients with previous surgical mitral valve replacement (MVR) are also indicated for TAVR, there might increase the risk of malposition of device, stuck of mechanical valve leaflet, or paravalvular leakage (PVL). My objective is to review the risk of TAVR in patients with prosthetic mitral valve with some experimental study. TAVR patients with prosthetic mitral valve had similar mortality and morbidity compared with TAVR without prosthetic mitral valve. Transcatheter heart valve (THV) migration or interaction to mitral prosthetic valve was rare. Interference of THV with prosthetic valve was high when aorto-mitral angle was less than 90° and mitral prosthesis distance was less than 7 mm in my experimental study in vitro. Anatomically implanted bileaflet valve (oriented like anterior and posterior mitral valve) or anti-anatomically implanted single tilting disc valve (major orifice opening to the left ventricular outflow tract) is a risk of impingement and stuck with THV. Preoperative evaluation of aorto-mitral anatomy and prosthetic valve implantation method by multi-modalities are important.