Key result
Urgent transcatheter mitral ViV with VA-ECMO reduces mean gradient to 4 mmHg in cardiogenic shock.
Why the study?
Critical mitral valve stenosis due to failed bioprosthetic valves has high morbidity and mortality, and transcatheter Valve-in-Valve approaches are emerging as treatment options in high-risk patients.
Case Report (n=1)
Urgent transcatheter mitral valve-in-valve replacement with VA-ECMO support is technically feasible for high-risk patients with cardiogenic shock due to failed bioprosthetic valves.
Supports feasibility of urgent mitral ViV with VA-ECMO in cardiogenic shock; hypothesis-generating and should not change practice.
Critical mitral valve stenosis due to a failed bioprosthetic valve is associated with significant morbidity and mortality, with the transcatheter Valve-in-Valve (ViV) approach becoming a popular treatment option. We present a case of cardiogenic shock secondary to a stenotic mitral bio-prosthetic valve. The Heart team was consulted; the patient was a high-risk surgical candidate for valve replacement. He required venoarterial extracorporeal membrane oxygenation as a bridge to definitive therapy. The patient underwent a successful urgent transcatheter mitral ViV procedure with a trans-septal approach. Follow-up echocardiography showed significant improvement in mitral valve dynamics. Recently emerging transcatheter approaches for mitral ViV implantation after balloon valvuloplasty into a failed mitral valve prosthesis are technically feasible in high-risk patient populations and should be considered over re-operative mitral valve surgery.
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Jawad et al. (2024) conducted a case report in Severe mitral stenosis due to failed bioprosthetic mitral valve with cardiogenic shock (n=1). Urgent transcatheter transseptal mitral Valve-in-Valve (ViV) replacement with VA-ECMO support was evaluated on Mean mitral valve pressure gradient. Urgent transcatheter mitral valve-in-valve replacement with VA-ECMO support successfully reduced the mean mitral valve pressure gradient from 30 mmHg to 4 mmHg in a patient with cardiogenic shock.
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