Effects of Transapical Transcatheter Mitral Valve Implantation.

Ming-Chon Hsiung,Kuan-Chih Huang,Wei-Hsuan Chiang,Tien-Ping Tsao,Tao-Hsin Tung,Yung-Tsai Lee,Pei-En Chen,Kuo-Chen Lee,Jeng Wei,Wei-Hsian Yin

doi:10.3389/fcvm.2021.633369

Abstract

Purpose: In this study, transapical transcatheter mitral valve-in-valve implantation (TAMVI) was compared with surgical redo mitral valve replacement (SRMVR) in terms of clinical outcomes.Methods: We retrospectively identified patients with degenerated mitral bioprosthesis or failed annuloplasty rings who underwent redo SRMVR or TAMVI at our medical center. Clinical outcomes were based on echocardiography results.Results: We retrospectively identified patients with symptomatic mitral bioprosthetic valve dysfunction (n = 58) and failed annuloplasty rings (n = 14) who underwent redo SRMVR (n = 36) or TAMVI (n = 36). The Society of Thoracic Surgeons Predicted Risk of Mortality scores were higher in the TAMVI group (median: 9.52) than in the SRMVR group (median: 5.59) (p-value = 0.02). TAMVI patients were more severe in New York Heart Association (p-value = 0.04). The total procedure time (skin to skin) and length of stay after procedures were significantly shorter in the TAMVI group, and no significant difference in mortality was noted after adjustment for confounding factors (p-value = 0.11). The overall mean mitral valve pressure gradient was lower in the TAMVI group than in the SRMVR group at 24 months (p < 0.01). Both groups presented a decrease in the severity of mitral and tricuspid regurgitation at 3–24 months.Conclusions: In conclusion, the statistical analysis is still not robust enough to make a claim that TAMVI is an appropriate alternative. The outcome of the patient appears only to be related to the patient's pre-operative STS score. Additional multi-center, longitudinal studies are warranted to adequately assess the effect of TAMVI.

Highlights

Over the past two decades, transcatheter aortic valve implantation (TAVI) has been established as a viable alternative treatment to deal with severe aortic stenosis in patients at risk of open-heart surgery
There have been a relatively small number of reports pertaining to the clinical outcomes and echocardiographic findings following transcatheter mitral valve-in-valve implantation (TAMVI) or surgical redo mitral valve replacement (SRMVR) for degenerated bioprosthetic valve or failed annuloplasty rings
Since its introduction in 2009, transcatheter mitral valve-in-valve implantation has been increasingly adopted for the treatment of patients with malfunctioning bioprosthesis [18]

Summary

Introduction

Over the past two decades, transcatheter aortic valve implantation (TAVI) has been established as a viable alternative treatment to deal with severe aortic stenosis in patients at risk of open-heart surgery. This procedure has been extended to patients facing low-to-intermediate operative risk. Transapical transcatheter mitral valve-in-valve implantation (TAMVI) is regarded as a promising alternative treatment for patients with degenerated bioprosthesis or failed annuloplasty [3]. There have been a relatively small number of reports pertaining to the clinical outcomes and echocardiographic findings following TAMVI or surgical redo mitral valve replacement (SRMVR) for degenerated bioprosthetic valve or failed annuloplasty rings. We sought to determine whether TAMVI could achieve outcomes on par with those of SRMVR at 3, 6, 12, and 24 months after the procedure in terms of mortality rates and echocardiographic findings

Methods

Results

Discussion

Conclusion