Early Outcomes of Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification

Mackram Eleid, Brian K. Whisenant, Allison K. Cabalka, Mathew R. Williams, Mohammed Nejjari, David Attias, Neil Fam, Nicholas Amoroso, Thomas A. Foley, Peter M. Pollak, Oluseun O. Alli, Sorin V. Pislaru, Sameh M. Said, Joseph A. Dearani, Charanjit Rihal

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objectives The aim of this study was to examine 1-year outcomes of transseptal balloon-expandable transcatheter heart valve implantation in failed mitral bioprosthesis, ring annuloplasty, and mitral annular calcification (MAC). Background Immediate outcomes following transseptal mitral valve implantation in failed bioprostheses are favorable, but data on subsequent outcomes are lacking. Methods Percutaneous transseptal implantation of balloon-expandable transcatheter heart valves was performed in 87 patients with degenerated mitral bioprostheses (valve in valve [VIV]) (n = 60), previous ring annuloplasty (valve in ring) (n = 15), and severe MAC (valve in MAC) (n = 12). Results The mean Society of Thoracic Surgeons risk score was 13 ± 8%, and the mean age was 75 ± 11 years. Acute procedural success was achieved in 78 of 87 patients (90%) in the overall group and 58 of 60 (97%) in the VIV group, with a success rate of 20 of 27 (74%) in the valve in ring/valve in MAC group. Thirty-day survival free of death and cardiovascular surgery was 95% (95% confidence interval [CI]: 92% to 97%) in the VIV subgroup and 78% (95% CI: 70% to 86%) in the valve in ring/valve in MAC group (p = 0.008). One-year survival free of death and cardiovascular surgery was 86% (95% CI: 81% to 91%) in the VIV group compared with 68% (95% CI: 58% to 78%) (p = 0.008). At 1 year, 36 of 40 patients (90%) had New York Heart Association functional class I or II symptoms, no patients had more than mild residual mitral prosthetic or periprosthetic regurgitation, and the mean transvalvular gradient was 7 ± 3 mm Hg. Conclusions One-year outcomes following successful transseptal balloon-expandable transcatheter heart valve implantation in high-risk patients with degenerated mitral bioprostheses are excellent, characterized by durable symptom relief and prosthesis function. Although mitral valve in ring and valve in MAC have higher operative morbidity and mortality, 1-year outcomes after an initially successful procedure are favorable in carefully selected patients.

Original languageEnglish (US)
Pages (from-to)1932-1942
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume10
Issue number19
DOIs
StatePublished - Oct 9 2017

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Mitral Valve Annuloplasty
Mitral Valve
Bioprosthesis
Heart Valves
Confidence Intervals
Survival
Prostheses and Implants
Morbidity
Mortality

Keywords

  • mitral valve implantation
  • percutaneous
  • transcatheter valve
  • transseptal

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Early Outcomes of Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification. / Eleid, Mackram; Whisenant, Brian K.; Cabalka, Allison K.; Williams, Mathew R.; Nejjari, Mohammed; Attias, David; Fam, Neil; Amoroso, Nicholas; Foley, Thomas A.; Pollak, Peter M.; Alli, Oluseun O.; Pislaru, Sorin V.; Said, Sameh M.; Dearani, Joseph A.; Rihal, Charanjit.

In: JACC: Cardiovascular Interventions, Vol. 10, No. 19, 09.10.2017, p. 1932-1942.

Research output: Contribution to journalArticle

Eleid, M, Whisenant, BK, Cabalka, AK, Williams, MR, Nejjari, M, Attias, D, Fam, N, Amoroso, N, Foley, TA, Pollak, PM, Alli, OO, Pislaru, SV, Said, SM, Dearani, JA & Rihal, C 2017, 'Early Outcomes of Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification', JACC: Cardiovascular Interventions, vol. 10, no. 19, pp. 1932-1942. https://doi.org/10.1016/j.jcin.2017.08.014
Eleid, Mackram ; Whisenant, Brian K. ; Cabalka, Allison K. ; Williams, Mathew R. ; Nejjari, Mohammed ; Attias, David ; Fam, Neil ; Amoroso, Nicholas ; Foley, Thomas A. ; Pollak, Peter M. ; Alli, Oluseun O. ; Pislaru, Sorin V. ; Said, Sameh M. ; Dearani, Joseph A. ; Rihal, Charanjit. / Early Outcomes of Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification. In: JACC: Cardiovascular Interventions. 2017 ; Vol. 10, No. 19. pp. 1932-1942.
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title = "Early Outcomes of Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification",
abstract = "Objectives The aim of this study was to examine 1-year outcomes of transseptal balloon-expandable transcatheter heart valve implantation in failed mitral bioprosthesis, ring annuloplasty, and mitral annular calcification (MAC). Background Immediate outcomes following transseptal mitral valve implantation in failed bioprostheses are favorable, but data on subsequent outcomes are lacking. Methods Percutaneous transseptal implantation of balloon-expandable transcatheter heart valves was performed in 87 patients with degenerated mitral bioprostheses (valve in valve [VIV]) (n = 60), previous ring annuloplasty (valve in ring) (n = 15), and severe MAC (valve in MAC) (n = 12). Results The mean Society of Thoracic Surgeons risk score was 13 ± 8{\%}, and the mean age was 75 ± 11 years. Acute procedural success was achieved in 78 of 87 patients (90{\%}) in the overall group and 58 of 60 (97{\%}) in the VIV group, with a success rate of 20 of 27 (74{\%}) in the valve in ring/valve in MAC group. Thirty-day survival free of death and cardiovascular surgery was 95{\%} (95{\%} confidence interval [CI]: 92{\%} to 97{\%}) in the VIV subgroup and 78{\%} (95{\%} CI: 70{\%} to 86{\%}) in the valve in ring/valve in MAC group (p = 0.008). One-year survival free of death and cardiovascular surgery was 86{\%} (95{\%} CI: 81{\%} to 91{\%}) in the VIV group compared with 68{\%} (95{\%} CI: 58{\%} to 78{\%}) (p = 0.008). At 1 year, 36 of 40 patients (90{\%}) had New York Heart Association functional class I or II symptoms, no patients had more than mild residual mitral prosthetic or periprosthetic regurgitation, and the mean transvalvular gradient was 7 ± 3 mm Hg. Conclusions One-year outcomes following successful transseptal balloon-expandable transcatheter heart valve implantation in high-risk patients with degenerated mitral bioprostheses are excellent, characterized by durable symptom relief and prosthesis function. Although mitral valve in ring and valve in MAC have higher operative morbidity and mortality, 1-year outcomes after an initially successful procedure are favorable in carefully selected patients.",
keywords = "mitral valve implantation, percutaneous, transcatheter valve, transseptal",
author = "Mackram Eleid and Whisenant, {Brian K.} and Cabalka, {Allison K.} and Williams, {Mathew R.} and Mohammed Nejjari and David Attias and Neil Fam and Nicholas Amoroso and Foley, {Thomas A.} and Pollak, {Peter M.} and Alli, {Oluseun O.} and Pislaru, {Sorin V.} and Said, {Sameh M.} and Dearani, {Joseph A.} and Charanjit Rihal",
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TY - JOUR

T1 - Early Outcomes of Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification

AU - Eleid, Mackram

AU - Whisenant, Brian K.

AU - Cabalka, Allison K.

AU - Williams, Mathew R.

AU - Nejjari, Mohammed

AU - Attias, David

AU - Fam, Neil

AU - Amoroso, Nicholas

AU - Foley, Thomas A.

AU - Pollak, Peter M.

AU - Alli, Oluseun O.

AU - Pislaru, Sorin V.

AU - Said, Sameh M.

AU - Dearani, Joseph A.

AU - Rihal, Charanjit

PY - 2017/10/9

Y1 - 2017/10/9

N2 - Objectives The aim of this study was to examine 1-year outcomes of transseptal balloon-expandable transcatheter heart valve implantation in failed mitral bioprosthesis, ring annuloplasty, and mitral annular calcification (MAC). Background Immediate outcomes following transseptal mitral valve implantation in failed bioprostheses are favorable, but data on subsequent outcomes are lacking. Methods Percutaneous transseptal implantation of balloon-expandable transcatheter heart valves was performed in 87 patients with degenerated mitral bioprostheses (valve in valve [VIV]) (n = 60), previous ring annuloplasty (valve in ring) (n = 15), and severe MAC (valve in MAC) (n = 12). Results The mean Society of Thoracic Surgeons risk score was 13 ± 8%, and the mean age was 75 ± 11 years. Acute procedural success was achieved in 78 of 87 patients (90%) in the overall group and 58 of 60 (97%) in the VIV group, with a success rate of 20 of 27 (74%) in the valve in ring/valve in MAC group. Thirty-day survival free of death and cardiovascular surgery was 95% (95% confidence interval [CI]: 92% to 97%) in the VIV subgroup and 78% (95% CI: 70% to 86%) in the valve in ring/valve in MAC group (p = 0.008). One-year survival free of death and cardiovascular surgery was 86% (95% CI: 81% to 91%) in the VIV group compared with 68% (95% CI: 58% to 78%) (p = 0.008). At 1 year, 36 of 40 patients (90%) had New York Heart Association functional class I or II symptoms, no patients had more than mild residual mitral prosthetic or periprosthetic regurgitation, and the mean transvalvular gradient was 7 ± 3 mm Hg. Conclusions One-year outcomes following successful transseptal balloon-expandable transcatheter heart valve implantation in high-risk patients with degenerated mitral bioprostheses are excellent, characterized by durable symptom relief and prosthesis function. Although mitral valve in ring and valve in MAC have higher operative morbidity and mortality, 1-year outcomes after an initially successful procedure are favorable in carefully selected patients.

AB - Objectives The aim of this study was to examine 1-year outcomes of transseptal balloon-expandable transcatheter heart valve implantation in failed mitral bioprosthesis, ring annuloplasty, and mitral annular calcification (MAC). Background Immediate outcomes following transseptal mitral valve implantation in failed bioprostheses are favorable, but data on subsequent outcomes are lacking. Methods Percutaneous transseptal implantation of balloon-expandable transcatheter heart valves was performed in 87 patients with degenerated mitral bioprostheses (valve in valve [VIV]) (n = 60), previous ring annuloplasty (valve in ring) (n = 15), and severe MAC (valve in MAC) (n = 12). Results The mean Society of Thoracic Surgeons risk score was 13 ± 8%, and the mean age was 75 ± 11 years. Acute procedural success was achieved in 78 of 87 patients (90%) in the overall group and 58 of 60 (97%) in the VIV group, with a success rate of 20 of 27 (74%) in the valve in ring/valve in MAC group. Thirty-day survival free of death and cardiovascular surgery was 95% (95% confidence interval [CI]: 92% to 97%) in the VIV subgroup and 78% (95% CI: 70% to 86%) in the valve in ring/valve in MAC group (p = 0.008). One-year survival free of death and cardiovascular surgery was 86% (95% CI: 81% to 91%) in the VIV group compared with 68% (95% CI: 58% to 78%) (p = 0.008). At 1 year, 36 of 40 patients (90%) had New York Heart Association functional class I or II symptoms, no patients had more than mild residual mitral prosthetic or periprosthetic regurgitation, and the mean transvalvular gradient was 7 ± 3 mm Hg. Conclusions One-year outcomes following successful transseptal balloon-expandable transcatheter heart valve implantation in high-risk patients with degenerated mitral bioprostheses are excellent, characterized by durable symptom relief and prosthesis function. Although mitral valve in ring and valve in MAC have higher operative morbidity and mortality, 1-year outcomes after an initially successful procedure are favorable in carefully selected patients.

KW - mitral valve implantation

KW - percutaneous

KW - transcatheter valve

KW - transseptal

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U2 - 10.1016/j.jcin.2017.08.014

DO - 10.1016/j.jcin.2017.08.014

M3 - Article

VL - 10

SP - 1932

EP - 1942

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

SN - 1936-8798

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