Abstract 12723: The Tendyne Valve: A Novel Approach to Mitral Valve Replacement

Abstract

Clinical Presentation: 64-year-old female with history of CAD with STEMI s/p PCI of RCA, HFrEF (45%), afib, HTN, DM2, severe MR and moderate calcific MS presented with shortness of breath found to have recurrent CHF. She was not amenable to surgical valve replacement and standard transcatheter percutaneous options are limited given the significant MAC. Tendyne (Abbot) transcatheter mitral valve implantation (TMVI) is an experimental minimally invasive option to treat significant MR with challenging mitral anatomy. Patient underwent a minimal apical thoracotomy via TEE guidance, placement of delivery catheter and valve deployment followed by an apical tether to maintain adequate tension. Post-deployment, there was no significant MR, MS or LVOT obstruction. Imaging Findings: See Image. Discussion: TEE is critical from pre-procedure planning to device implant and post-procedural monitoring. Pre-procedural planning requires accurate understanding of the mitral valve anatomy. During the trans-apical thoracotomy, TEE is essential in confirming correct puncture site to ensure appropriate delivery catheter position. Once appropriately positioned, evaluation via color doppler nad 3D are necessary to evaluate device seating, residual regurgitation and LVOT obstruction. Once apical cap is tethered into apex, the valve is re-visualized on TEE to ensure appropriate valve tension prior to closure of thoracotomy. Conclusion: TENDYNE TMVI is a reasonable option to consider for patients with significant MR and challenging mitral anatomy and not an open surgical candidate. TEE imaging is critical to optimize valve implantation both pre-procedural and post-procedural.