Title
Percutaneous complete repair of failed mitral valve prosthesis: simultaneous closure of mitral paravalvular leaks and transcatheter mitral valve implantation - single-centre experience
Publication Date
2014
Journal Title
EuroIntervention
Abstract
Aims: Structural deterioration and paravalvular leak (PVL) are complications associated with surgically implanted prosthetic valves, historically requiring reoperation. We present our experience of complete transcatheter repair of a degenerated mitral bioprosthesis. Methods and results: From March 2012 to October 2012, we reviewed consecutive, high-risk surgical patients (n=5) who underwent transcatheter repair of a failed mitral bioprosthesis with severe paravalvular regurgitation (PVR). Manufacturer valve sizes ranged from 27 to 33 mm, regurgitation (n=1), stenosis (n=1), or both (n=3). Percutaneous transapical and transseptal access were achieved with PVL closure performed transapically. An arteriovenous rail was created for transseptal delivery of a Melody valve. All patients had successful PVL closure with no residual PVR. Valve-in-valve (ViV) implantation was successful in four patients. Overall, mean transvalvular mitral gradient was 11.2 mmHg pre-procedure which improved to 5 mmHg post-procedure. Improvement of NYHA Class >/=2 was achieved in all patients (19+/-3 months). One patient had controlled Melody valve embolisation which required emergent surgical replacement. Inner valve diameter was 26 mm, too large for Melody valve implantation. Conclusions: Complete transcatheter repair of a degenerated mitral bioprosthesis with PVR can be performed in the high-risk patient. Accurate measurement is necessary prior to intervention, with concern for embolisation among the larger valve sizes (>31 mm).
Volume Number
10
Issue Number
11
Pages
1336-1345
Document Type
Article
EPub Date
2014/05/08
Status
Faculty
Facility
School of Medicine
Primary Department
Cardiology
Additional Departments
Cardiovascular and Thoracic Surgery
PMID
DOI
10.4244/eijy14m05_01
This document is currently not available here.
COinS
Comments
Hofstra Northwell School of Medicine and Northwell Health currently do not subscribe to this title. If you are an affiliate and would like to access the full text please request it via interlibrary loan via Hofstra Northwell School of Medicine ILL (faculty and students only) or Northwell Health ILL