Percutaneous Approach to the Mitral Valve: The Prince Charles Experience

Abstract

Purpose: Open-heart surgery remains the gold standard for the treatment of severe mitral valve disease. The modern challenge facing surgeons, to provide a safe intervention for the rising population of high-risk patients presenting for either primary or redo surgery, has led to the development of novel percutaneous approaches to the mitral valve. We describe our initial experience with transcatheter mitral valve replacements in high-risk patients. Methodology: Ten patients (mean age 82 ± 2 years) received transapical transcatheter mitral valve implantation between February 2011 and June 2016. All patients were considered high risk for conventional surgery after evaluation by a multidisciplinary heart team. Implantation of a balloon-expandable heart valve (Sapien) into a degenerated mitral valve bioprosthesis was performed in four patients, whilst six received a self-expanding bioprosthesis (Tendyne) for severe mitral regurgitation. Results: Implantation was successful in all patients, with reduction of median mitral regurgitation from grade 4 (IQR: 3-4) to 0 (p < 0.01). Trace paravalvular regurgitation was seen in 3 patients. In-hospital mortality occurred in 2 patients due to stroke and septic shock, on postoperative days 3 and 13, respectively. Length of stay was 10 (IQR: 8-12) days. NYHA class improved from 3 (IQR: 3-4) to 2 (IQR: 1.5-2, P < 0.01) over a median follow-up of 30 (range 30-958) days. Conclusion: Transapical transcatheter mitral valve replacement may provide an alternative strategy to deal with the increasing rise of high-risk patients presenting for primary and reoperative mitral valve surgery. Our initial experience with this approach has demonstrated its early feasibility in select patients.