Transcatheter transseptal mitral valve implantation with Edwards SAPIEN 3: the first experience of a single center.

Abstract

In recent years, there has been a clear trend towards increased mitral bioprosthetic valve surgery in comparison to mechanical prostheses [1]. According to the ESC Guidelines mitral bioprostheses are recommended for patients > 70 years old or those with a life expectancy lower than the presumed durability of the bioprosthesis (class IIa/C). Importantly, the guidelines also recognize the prominence of quality of life after cardiosurgery and focus on patients’ preferences (class Ic), especially if long-term anticoagulation is nonoptimal (class Ic) [2]. Structural deterioration of mitral bioprostheses (structural valve deterioration – SVD) is the main limitation for their use. The average lifespan of a bioprosthetic valve is estimated at 16 years and the reoperation due to SVD affects as many as 75% of patients after a 20-year follow-up [3, 4]. Reoperation is usually associated with high risk of complications and mortality [5, 6]. The alternative option is transcatheter mitral valve implantation (TMVI), especially in patients with high surgical risk. TMVI is indicated in patients with a degenerated mitral bioprosthesis or mitral regurgitation after mitral annuloplasty rings. The results of TMVI have been reported in registries and single-center or case reports [7–10]. Technically, TMVI is feasible via a transapical approach or through venous access and atrial septum puncture. The transapical approach has been dominant in TMVI as it was well tried in transcatheter aortic valve implantation (TAVI) procedures. The transseptal approach is technically more demanding yet due to lesser invasiveness it may lead to superior early and late treatment effects [8]. The latest American registry STS/ACC/TVT reports similar prevalence of TMVI procedures with both approaches [7].