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

Mackram Eleid, Allison K. Cabalka, Matthew R. Williams, Brian K. Whisenant, Oluseun O. Alli, Neil Fam, Peter M. Pollak, Firas Barrow, Joseph F. Malouf, Rick A. Nishimura, Lyle D. Joyce, Joseph A. Dearani, Charanjit Rihal

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Objectives This study sought to examine the feasibility, safety, and intermediate-term outcomes in patients undergoing percutaneous transvenous transcatheter mitral valve implantation in failed bioprosthesis, ring annuloplasty, and calcific mitral stenosis. Background Surgical mitral valve replacement in patients with previous surgery or severe mitral annular calcification (MAC) is often associated with high or prohibitive risk. Methods Percutaneous transfemoral antegrade transseptal implantation of Edwards SAPIEN prosthesis (Edwards Lifesciences, Irvine, California) was performed in 48 patients with degenerated mitral bioprosthesis (n = 33), previous ring annuloplasty (n = 9), and severe MAC (n = 6). Results The mean Society of Thoracic Surgeons risk score was 13.2 ± 7.4% with a mean age 76 ± 11 years. Acute procedural success was achieved in 42 of 48 patients (88%) in the overall group and 31 of 33 (94%) in the failed bioprosthetic mitral valve group and success rate of 11 of 15 (73%) in patients with failed annuloplasty rings and MAC. After successful procedure, no patients had > mild residual mitral prosthetic or periprosthetic regurgitation; mean transvalvular gradients were 6 ± 2.5 mm Hg. Thirty-day survival free of death and cardiovascular surgery was 85% in the overall group and 91% in the failed bioprosthetic mitral valve subgroup. Conclusions Transfemoral percutaneous transvenous mitral valve implantation in high-risk patients with degenerated bioprosthesis is safe, effective, and associated with rapid improvement in hemodynamics, short length of stays, and improved functional status. Percutaneous mitral valve implantation in patients with failed annuloplasty rings and severe MAC is a promising therapy with significant short-term morbidity and mortality that requires further study.

Original languageEnglish (US)
Pages (from-to)1161-1174
Number of pages14
JournalJACC: Cardiovascular Interventions
Volume9
Issue number11
DOIs
StatePublished - 2016

Fingerprint

Mitral Valve
Bioprosthesis
Mitral Valve Annuloplasty
Mitral Valve Stenosis
Surgical Instruments
Prostheses and Implants
Length of Stay
Hemodynamics
Morbidity
Safety
Survival
Mortality

Keywords

  • mitral valve implantation
  • percutaneous
  • transcatheter valve
  • transseptal

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification. / Eleid, Mackram; Cabalka, Allison K.; Williams, Matthew R.; Whisenant, Brian K.; Alli, Oluseun O.; Fam, Neil; Pollak, Peter M.; Barrow, Firas; Malouf, Joseph F.; Nishimura, Rick A.; Joyce, Lyle D.; Dearani, Joseph A.; Rihal, Charanjit.

In: JACC: Cardiovascular Interventions, Vol. 9, No. 11, 2016, p. 1161-1174.

Research output: Contribution to journalArticle

Eleid, M, Cabalka, AK, Williams, MR, Whisenant, BK, Alli, OO, Fam, N, Pollak, PM, Barrow, F, Malouf, JF, Nishimura, RA, Joyce, LD, Dearani, JA & Rihal, C 2016, 'Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification', JACC: Cardiovascular Interventions, vol. 9, no. 11, pp. 1161-1174. https://doi.org/10.1016/j.jcin.2016.02.041
Eleid, Mackram ; Cabalka, Allison K. ; Williams, Matthew R. ; Whisenant, Brian K. ; Alli, Oluseun O. ; Fam, Neil ; Pollak, Peter M. ; Barrow, Firas ; Malouf, Joseph F. ; Nishimura, Rick A. ; Joyce, Lyle D. ; Dearani, Joseph A. ; Rihal, Charanjit. / Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification. In: JACC: Cardiovascular Interventions. 2016 ; Vol. 9, No. 11. pp. 1161-1174.
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title = "Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification",
abstract = "Objectives This study sought to examine the feasibility, safety, and intermediate-term outcomes in patients undergoing percutaneous transvenous transcatheter mitral valve implantation in failed bioprosthesis, ring annuloplasty, and calcific mitral stenosis. Background Surgical mitral valve replacement in patients with previous surgery or severe mitral annular calcification (MAC) is often associated with high or prohibitive risk. Methods Percutaneous transfemoral antegrade transseptal implantation of Edwards SAPIEN prosthesis (Edwards Lifesciences, Irvine, California) was performed in 48 patients with degenerated mitral bioprosthesis (n = 33), previous ring annuloplasty (n = 9), and severe MAC (n = 6). Results The mean Society of Thoracic Surgeons risk score was 13.2 ± 7.4{\%} with a mean age 76 ± 11 years. Acute procedural success was achieved in 42 of 48 patients (88{\%}) in the overall group and 31 of 33 (94{\%}) in the failed bioprosthetic mitral valve group and success rate of 11 of 15 (73{\%}) in patients with failed annuloplasty rings and MAC. After successful procedure, no patients had > mild residual mitral prosthetic or periprosthetic regurgitation; mean transvalvular gradients were 6 ± 2.5 mm Hg. Thirty-day survival free of death and cardiovascular surgery was 85{\%} in the overall group and 91{\%} in the failed bioprosthetic mitral valve subgroup. Conclusions Transfemoral percutaneous transvenous mitral valve implantation in high-risk patients with degenerated bioprosthesis is safe, effective, and associated with rapid improvement in hemodynamics, short length of stays, and improved functional status. Percutaneous mitral valve implantation in patients with failed annuloplasty rings and severe MAC is a promising therapy with significant short-term morbidity and mortality that requires further study.",
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author = "Mackram Eleid and Cabalka, {Allison K.} and Williams, {Matthew R.} and Whisenant, {Brian K.} and Alli, {Oluseun O.} and Neil Fam and Pollak, {Peter M.} and Firas Barrow and Malouf, {Joseph F.} and Nishimura, {Rick A.} and Joyce, {Lyle D.} and Dearani, {Joseph A.} and Charanjit Rihal",
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T1 - Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification

AU - Eleid, Mackram

AU - Cabalka, Allison K.

AU - Williams, Matthew R.

AU - Whisenant, Brian K.

AU - Alli, Oluseun O.

AU - Fam, Neil

AU - Pollak, Peter M.

AU - Barrow, Firas

AU - Malouf, Joseph F.

AU - Nishimura, Rick A.

AU - Joyce, Lyle D.

AU - Dearani, Joseph A.

AU - Rihal, Charanjit

PY - 2016

Y1 - 2016

N2 - Objectives This study sought to examine the feasibility, safety, and intermediate-term outcomes in patients undergoing percutaneous transvenous transcatheter mitral valve implantation in failed bioprosthesis, ring annuloplasty, and calcific mitral stenosis. Background Surgical mitral valve replacement in patients with previous surgery or severe mitral annular calcification (MAC) is often associated with high or prohibitive risk. Methods Percutaneous transfemoral antegrade transseptal implantation of Edwards SAPIEN prosthesis (Edwards Lifesciences, Irvine, California) was performed in 48 patients with degenerated mitral bioprosthesis (n = 33), previous ring annuloplasty (n = 9), and severe MAC (n = 6). Results The mean Society of Thoracic Surgeons risk score was 13.2 ± 7.4% with a mean age 76 ± 11 years. Acute procedural success was achieved in 42 of 48 patients (88%) in the overall group and 31 of 33 (94%) in the failed bioprosthetic mitral valve group and success rate of 11 of 15 (73%) in patients with failed annuloplasty rings and MAC. After successful procedure, no patients had > mild residual mitral prosthetic or periprosthetic regurgitation; mean transvalvular gradients were 6 ± 2.5 mm Hg. Thirty-day survival free of death and cardiovascular surgery was 85% in the overall group and 91% in the failed bioprosthetic mitral valve subgroup. Conclusions Transfemoral percutaneous transvenous mitral valve implantation in high-risk patients with degenerated bioprosthesis is safe, effective, and associated with rapid improvement in hemodynamics, short length of stays, and improved functional status. Percutaneous mitral valve implantation in patients with failed annuloplasty rings and severe MAC is a promising therapy with significant short-term morbidity and mortality that requires further study.

AB - Objectives This study sought to examine the feasibility, safety, and intermediate-term outcomes in patients undergoing percutaneous transvenous transcatheter mitral valve implantation in failed bioprosthesis, ring annuloplasty, and calcific mitral stenosis. Background Surgical mitral valve replacement in patients with previous surgery or severe mitral annular calcification (MAC) is often associated with high or prohibitive risk. Methods Percutaneous transfemoral antegrade transseptal implantation of Edwards SAPIEN prosthesis (Edwards Lifesciences, Irvine, California) was performed in 48 patients with degenerated mitral bioprosthesis (n = 33), previous ring annuloplasty (n = 9), and severe MAC (n = 6). Results The mean Society of Thoracic Surgeons risk score was 13.2 ± 7.4% with a mean age 76 ± 11 years. Acute procedural success was achieved in 42 of 48 patients (88%) in the overall group and 31 of 33 (94%) in the failed bioprosthetic mitral valve group and success rate of 11 of 15 (73%) in patients with failed annuloplasty rings and MAC. After successful procedure, no patients had > mild residual mitral prosthetic or periprosthetic regurgitation; mean transvalvular gradients were 6 ± 2.5 mm Hg. Thirty-day survival free of death and cardiovascular surgery was 85% in the overall group and 91% in the failed bioprosthetic mitral valve subgroup. Conclusions Transfemoral percutaneous transvenous mitral valve implantation in high-risk patients with degenerated bioprosthesis is safe, effective, and associated with rapid improvement in hemodynamics, short length of stays, and improved functional status. Percutaneous mitral valve implantation in patients with failed annuloplasty rings and severe MAC is a promising therapy with significant short-term morbidity and mortality that requires further study.

KW - mitral valve implantation

KW - percutaneous

KW - transcatheter valve

KW - transseptal

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