Author + information
- Received May 25, 2015
- Accepted June 23, 2015
- Published online December 21, 2015.
- Gagan D. Singh, MD∗,
- Thomas W. Smith, MD∗,
- Walter D. Boyd, MD†,
- Jeffrey A. Southard, MD∗,
- Garrett B. Wong, MD∗,
- Femi Philip, MD∗,
- Reginald I. Low, MD∗ and
- Jason H. Rogers, MD∗∗ ()
- ∗Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California
- †Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, California
- ↵∗Reprint requests and correspondence:
Dr. Jason H. Rogers, Division of Cardiovascular Medicine, University of California Davis Medical Center, 4860 Y Street, Suite 2820, Sacramento, California 95616.
A 67-year-old woman (frail, body mass index of 18, forced expiratory volume1 of 0.86, Society of Thoracic Surgeons score of 12%) was referred for transcatheter correction of a severely degenerated bioprosthetic (29-mm Edwards Perimount Bovine Pericardial, Edwards Lifesciences, Irvine, California) mitral valve. Transesophageal echocardiography (TEE) confirmed severe bioprosthesis degeneration (Figure 1). A hybrid approach was used whereby paravalvular leak (PVL) was treated percutaneously followed by transseptal mitral valve-in-valve replacement (Figure 2). TEE confirmed complete correction of degenerated bioprosthetic mitral regurgitation (MR) (Figure 3). The patient was discharged with complete resolution of symptoms on follow-up.
The transapical (TA) route remains the most common for transcatheter mitral valve-in-valve replacement (1). However, patients with poor pulmonary reserve and thin body frames may be at prohibitive risk and may not tolerate the 24-F Ascendra sheath (Edwards Lifesciences) required for valve delivery. Herein we report a case of complete MR reduction by using a hybrid approach whereby the PVL is corrected first via the TA route. Additionally, the use of the hybrid approach allows the operator to create a coaxial atrioventricular rail and allows for optimal alignment of the valve-in-valve.
Dr. Rogers is a proctor for St. Jude Medical; and is on the Speakers Bureau of Edwards Lifesciences. Dr. Southard is on the Speakers Bureau of Edwards Lifesciences and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 25, 2015.
- Accepted June 23, 2015.
- American College of Cardiology Foundation