Direct transatrial implantation of balloon-expandable valve for mitral stenosis with severe annular calcifications

Early experience and lessons learned

Abdallah El Sabbagh, Mackram Eleid, Thomas A. Foley, Mohammed A. Al-Hijji, Richard C.Daly, Charanjit Rihal, Sameh M. Said

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

OBJECTIVES: Patients with symptomatic severe mitral annular calcification present a therapeutic challenge. Direct transatrial implantation of SAPIEN valve has emerged as an alternative to surgical mitral valve (MV) replacement for high-risk surgical candidates. METHODS: This series includes 6 consecutive patients with symptomatic severe mitral annular calcification deemed to be at high risk for standard surgery. All patients underwent direct transatrial implantation of balloon-expandable SAPIEN valve in the mitral position. RESULTS: Mean age was 81 years [3 (50%) female], with an average Society of Thoracic Surgeons score of 10.3%. All patients had at least New York Heart Association Class III symptoms. Procedure was performed using normothermic cardiopulmonary bypass. The MV was approached through a standard left atriotomy in 4 patients and via a vertical trans-septal approach in the remaining 2 patients. Resection of the anterior leaflet of the MV was performed in 4 patients. The valve was successfully deployed in all patients. The diastolic mean gradient across the MV decreased from an average of 14 ± 3 to 5 ± 1mmHg post deployment. There was no left ventricular outflow tract obstruction. MV periprosthetic regurgitation was severe in 3 patients and moderate to severe in 1 patient. In-hospital mortality occurred in 3 (50%) patients due to a non-cardiac cause in 1 patient and cardiogenic shock in the other 2 patients. CONCLUSIONS: Early experience with direct transatrial balloon-expandable implantation for severe mitral annular calcification revealed feasibility of this approach but significant morbidity and mortality primarily related to periprosthetic regurgitation that requires further refinement of the technique.

Original languageEnglish (US)
Pages (from-to)162-169
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume53
Issue number1
DOIs
StatePublished - Jan 1 2018

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Mitral Valve Stenosis
Mitral Valve
Ventricular Outflow Obstruction
Cardiogenic Shock
Mitral Valve Insufficiency
Hospital Mortality
Cardiopulmonary Bypass
Surgical Instruments

Keywords

  • Balloon-expandable valve
  • Mitral annular calcification
  • Transatrial

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Direct transatrial implantation of balloon-expandable valve for mitral stenosis with severe annular calcifications : Early experience and lessons learned. / Sabbagh, Abdallah El; Eleid, Mackram; Foley, Thomas A.; Al-Hijji, Mohammed A.; C.Daly, Richard; Rihal, Charanjit; Said, Sameh M.

In: European Journal of Cardio-thoracic Surgery, Vol. 53, No. 1, 01.01.2018, p. 162-169.

Research output: Contribution to journalArticle

Sabbagh, Abdallah El ; Eleid, Mackram ; Foley, Thomas A. ; Al-Hijji, Mohammed A. ; C.Daly, Richard ; Rihal, Charanjit ; Said, Sameh M. / Direct transatrial implantation of balloon-expandable valve for mitral stenosis with severe annular calcifications : Early experience and lessons learned. In: European Journal of Cardio-thoracic Surgery. 2018 ; Vol. 53, No. 1. pp. 162-169.
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N2 - OBJECTIVES: Patients with symptomatic severe mitral annular calcification present a therapeutic challenge. Direct transatrial implantation of SAPIEN valve has emerged as an alternative to surgical mitral valve (MV) replacement for high-risk surgical candidates. METHODS: This series includes 6 consecutive patients with symptomatic severe mitral annular calcification deemed to be at high risk for standard surgery. All patients underwent direct transatrial implantation of balloon-expandable SAPIEN valve in the mitral position. RESULTS: Mean age was 81 years [3 (50%) female], with an average Society of Thoracic Surgeons score of 10.3%. All patients had at least New York Heart Association Class III symptoms. Procedure was performed using normothermic cardiopulmonary bypass. The MV was approached through a standard left atriotomy in 4 patients and via a vertical trans-septal approach in the remaining 2 patients. Resection of the anterior leaflet of the MV was performed in 4 patients. The valve was successfully deployed in all patients. The diastolic mean gradient across the MV decreased from an average of 14 ± 3 to 5 ± 1mmHg post deployment. There was no left ventricular outflow tract obstruction. MV periprosthetic regurgitation was severe in 3 patients and moderate to severe in 1 patient. In-hospital mortality occurred in 3 (50%) patients due to a non-cardiac cause in 1 patient and cardiogenic shock in the other 2 patients. CONCLUSIONS: Early experience with direct transatrial balloon-expandable implantation for severe mitral annular calcification revealed feasibility of this approach but significant morbidity and mortality primarily related to periprosthetic regurgitation that requires further refinement of the technique.

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