Balloon-expandable valves for degenerated mitral xenografts or failing surgical rings

被引:27
作者
Schaefer, Ulrich [1 ]
Bader, Ralf [2 ]
Frerker, Christian [1 ]
Schewel, Dimitry [1 ]
Thielsen, Thomas [1 ]
Schmoeckel, Michael [2 ]
Kreidel, Felix [1 ]
Kuck, Karl-Heinz [2 ]
机构
[1] Asklepios Klin St Georg, Div Cardiol, Hamburg, Germany
[2] Asklepios Klin St Georg, Div Cardiac Surg, Hamburg, Germany
关键词
degenerated mitral bioprosthesis; mitral annuloplasty ring; transcatheter mitral valve-in-valve implantation; TRANSCATHETER VALVE; IMPLANTATION; REPLACEMENT; PROSTHESIS;
D O I
10.4244/EIJV10I2A42
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 cm(2), 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.
引用
收藏
页码:260 / 268
页数:9
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