Early Outcomes for Surgical Minimally Invasive SAPIEN 3 Transcatheter Mitral Valve Replacement

Abstract

Limited surgical options are available for patients with extensive mitral annular calcification. Several reports have shown the feasibility of surgical mitral valve replacement (MVR) using a transcatheter aortic valve in the mitral position (MVR-TAVR). This study reviewed 30-day and 1-year outcomes of a minimally invasive approach for MVR-TAVR. Between 2017 and 2019, 16 patients underwent MVR-TAVR under direct vision. Primary end points included overall survival, technical success, and effectiveness. Secondary end points included valve and cardiac hemodynamics postoperatively and during follow up. The 16 patients (69% female) were 53 to 88 years of age (average, 77 ± 9 years). Comorbidities on presentation were as follows: 31% (5 of 16) were reoperative procedures; 13% (3 of 16) of patients had right ventricular dysfunction, 31% (5 of 16) had severe pulmonary hypertension, and 20% (3 of 16) had chronic kidney disease. Isolated MVR-TAVR was performed on 69% (11 of 16) of patients, with a cross-clamp (58%; 7 of 12) or on a fibrillating heart (42%; 5 of 12), whereas concomitant MVR-TAVR was performed in 31% (5 of 16) of patients with a cross-clamp. At follow-up, the estimated 30-day mortality rate was 12.5%, and the 1-year mortality rate was 36.2%. A moderate postoperative paravalvular leak (PVL) was evident immediately in 1 patient, and a severe PVL was noted after 30-day follow-up in another. In addition, 1 patient had mild left ventricular outflow tract obstruction, and another had moderate mitral valve stenosis. At 1-year follow-up, there were no changes in the mild PVL and moderate stenosis identified postoperatively. Minithoracotomy MVR-TAVR is an acceptable alternative to conventional and transcatheter MVR in patients with mitral valve disease and extensive mitral annular calcification.