Short-term results of alcohol septal ablation as a bail-out strategy to treat severe left ventricular outflow tract obstruction after transcatheter mitral valve replacement in patients with severe mitral annular calcification

Mayra Guerrero, Dee Dee Wang, Dominique Himbert, Marina Urena, Amit Pursnani, Georges Kaddissi, Vijay Iyer, Michael Salinger, Tarun Chakravarty, Adam Greenbaum, Raj Makkar, Alec Vahanian, Ted Feldman, William O'Neill

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Objectives: To evaluate the outcomes of the early experience of percutaneous alcohol septal ablation in patients with severe left ventricular outflow tract (LVOT) obstruction post transcatheter mitral valve replacement (TMVR). Background: Severe LVOT obstruction with hemodynamic compromise is a complication of TMVR associated with high mortality. Percutaneous alcohol septal ablation has recently been described as a therapeutic option in this setting. Methods: Multicenter retrospective review of clinical outcomes of patients undergoing alcohol septal ablation to treat LVOT obstruction after TMVR for severe mitral stenosis with severe mitral annular calcification. Results: Six patients underwent percutaneous alcohol septal ablation to treat LVOT obstruction post-TMVR at six different centers. Five patients had immediate significant reduction in LVOT obstruction with improvement in hemodynamic status while one had persistent LVOT gradient but hemodynamic instability improved. The first patient died on postoperative day 4 due to complete heart block. One patient had initial improvement in LVOT gradient with recurrence on postoperative day 1 thought to be secondary to septal edema, was treated with surgical removal of the transcatheter valve and resection of the anterior mitral leaflet followed by transatrial TMVR and died 3 weeks later due to multi-organ failure. The remaining four patients improved clinically after alcohol septal ablation, were discharged from the hospital and were clinically stable at 30-day follow-up. Conclusions: Percutaneous alcohol ablation provides acute relief of TMVR-induced LVOT obstruction when septal hypertrophy is a contributing factor. This may be a safer alternative to bail-out surgery in this extremely high-risk patient population.

Original languageEnglish (US)
Pages (from-to)1220-1226
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume90
Issue number7
DOIs
StatePublished - Dec 1 2017
Externally publishedYes

Fingerprint

Ventricular Outflow Obstruction
Mitral Valve
Alcohols
Hemodynamics
Heart Block
bailing
Mitral Valve Stenosis
Hypertrophy
Edema
Recurrence
Mortality

Keywords

  • alcohol septal ablation
  • calcific mitral stenosis
  • left ventricular outflow tract obstruction
  • mitral annular calcification
  • mitral valve disease
  • transcatheter mitral valve replacement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Short-term results of alcohol septal ablation as a bail-out strategy to treat severe left ventricular outflow tract obstruction after transcatheter mitral valve replacement in patients with severe mitral annular calcification. / Guerrero, Mayra; Wang, Dee Dee; Himbert, Dominique; Urena, Marina; Pursnani, Amit; Kaddissi, Georges; Iyer, Vijay; Salinger, Michael; Chakravarty, Tarun; Greenbaum, Adam; Makkar, Raj; Vahanian, Alec; Feldman, Ted; O'Neill, William.

In: Catheterization and Cardiovascular Interventions, Vol. 90, No. 7, 01.12.2017, p. 1220-1226.

Research output: Contribution to journalArticle

Guerrero, Mayra ; Wang, Dee Dee ; Himbert, Dominique ; Urena, Marina ; Pursnani, Amit ; Kaddissi, Georges ; Iyer, Vijay ; Salinger, Michael ; Chakravarty, Tarun ; Greenbaum, Adam ; Makkar, Raj ; Vahanian, Alec ; Feldman, Ted ; O'Neill, William. / Short-term results of alcohol septal ablation as a bail-out strategy to treat severe left ventricular outflow tract obstruction after transcatheter mitral valve replacement in patients with severe mitral annular calcification. In: Catheterization and Cardiovascular Interventions. 2017 ; Vol. 90, No. 7. pp. 1220-1226.
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abstract = "Objectives: To evaluate the outcomes of the early experience of percutaneous alcohol septal ablation in patients with severe left ventricular outflow tract (LVOT) obstruction post transcatheter mitral valve replacement (TMVR). Background: Severe LVOT obstruction with hemodynamic compromise is a complication of TMVR associated with high mortality. Percutaneous alcohol septal ablation has recently been described as a therapeutic option in this setting. Methods: Multicenter retrospective review of clinical outcomes of patients undergoing alcohol septal ablation to treat LVOT obstruction after TMVR for severe mitral stenosis with severe mitral annular calcification. Results: Six patients underwent percutaneous alcohol septal ablation to treat LVOT obstruction post-TMVR at six different centers. Five patients had immediate significant reduction in LVOT obstruction with improvement in hemodynamic status while one had persistent LVOT gradient but hemodynamic instability improved. The first patient died on postoperative day 4 due to complete heart block. One patient had initial improvement in LVOT gradient with recurrence on postoperative day 1 thought to be secondary to septal edema, was treated with surgical removal of the transcatheter valve and resection of the anterior mitral leaflet followed by transatrial TMVR and died 3 weeks later due to multi-organ failure. The remaining four patients improved clinically after alcohol septal ablation, were discharged from the hospital and were clinically stable at 30-day follow-up. Conclusions: Percutaneous alcohol ablation provides acute relief of TMVR-induced LVOT obstruction when septal hypertrophy is a contributing factor. This may be a safer alternative to bail-out surgery in this extremely high-risk patient population.",
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T1 - Short-term results of alcohol septal ablation as a bail-out strategy to treat severe left ventricular outflow tract obstruction after transcatheter mitral valve replacement in patients with severe mitral annular calcification

AU - Guerrero, Mayra

AU - Wang, Dee Dee

AU - Himbert, Dominique

AU - Urena, Marina

AU - Pursnani, Amit

AU - Kaddissi, Georges

AU - Iyer, Vijay

AU - Salinger, Michael

AU - Chakravarty, Tarun

AU - Greenbaum, Adam

AU - Makkar, Raj

AU - Vahanian, Alec

AU - Feldman, Ted

AU - O'Neill, William

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Objectives: To evaluate the outcomes of the early experience of percutaneous alcohol septal ablation in patients with severe left ventricular outflow tract (LVOT) obstruction post transcatheter mitral valve replacement (TMVR). Background: Severe LVOT obstruction with hemodynamic compromise is a complication of TMVR associated with high mortality. Percutaneous alcohol septal ablation has recently been described as a therapeutic option in this setting. Methods: Multicenter retrospective review of clinical outcomes of patients undergoing alcohol septal ablation to treat LVOT obstruction after TMVR for severe mitral stenosis with severe mitral annular calcification. Results: Six patients underwent percutaneous alcohol septal ablation to treat LVOT obstruction post-TMVR at six different centers. Five patients had immediate significant reduction in LVOT obstruction with improvement in hemodynamic status while one had persistent LVOT gradient but hemodynamic instability improved. The first patient died on postoperative day 4 due to complete heart block. One patient had initial improvement in LVOT gradient with recurrence on postoperative day 1 thought to be secondary to septal edema, was treated with surgical removal of the transcatheter valve and resection of the anterior mitral leaflet followed by transatrial TMVR and died 3 weeks later due to multi-organ failure. The remaining four patients improved clinically after alcohol septal ablation, were discharged from the hospital and were clinically stable at 30-day follow-up. Conclusions: Percutaneous alcohol ablation provides acute relief of TMVR-induced LVOT obstruction when septal hypertrophy is a contributing factor. This may be a safer alternative to bail-out surgery in this extremely high-risk patient population.

AB - Objectives: To evaluate the outcomes of the early experience of percutaneous alcohol septal ablation in patients with severe left ventricular outflow tract (LVOT) obstruction post transcatheter mitral valve replacement (TMVR). Background: Severe LVOT obstruction with hemodynamic compromise is a complication of TMVR associated with high mortality. Percutaneous alcohol septal ablation has recently been described as a therapeutic option in this setting. Methods: Multicenter retrospective review of clinical outcomes of patients undergoing alcohol septal ablation to treat LVOT obstruction after TMVR for severe mitral stenosis with severe mitral annular calcification. Results: Six patients underwent percutaneous alcohol septal ablation to treat LVOT obstruction post-TMVR at six different centers. Five patients had immediate significant reduction in LVOT obstruction with improvement in hemodynamic status while one had persistent LVOT gradient but hemodynamic instability improved. The first patient died on postoperative day 4 due to complete heart block. One patient had initial improvement in LVOT gradient with recurrence on postoperative day 1 thought to be secondary to septal edema, was treated with surgical removal of the transcatheter valve and resection of the anterior mitral leaflet followed by transatrial TMVR and died 3 weeks later due to multi-organ failure. The remaining four patients improved clinically after alcohol septal ablation, were discharged from the hospital and were clinically stable at 30-day follow-up. Conclusions: Percutaneous alcohol ablation provides acute relief of TMVR-induced LVOT obstruction when septal hypertrophy is a contributing factor. This may be a safer alternative to bail-out surgery in this extremely high-risk patient population.

KW - alcohol septal ablation

KW - calcific mitral stenosis

KW - left ventricular outflow tract obstruction

KW - mitral annular calcification

KW - mitral valve disease

KW - transcatheter mitral valve replacement

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