Author + information
- Received December 9, 2015
- Revision received January 29, 2016
- Accepted February 25, 2016
- Published online June 13, 2016.
- Mackram F. Eleid, MDa,
- Allison K. Cabalka, MDa,
- Matthew R. Williams, MDb,
- Brian K. Whisenant, MDc,
- Oluseun O. Alli, MDd,
- Neil Fam, MDe,
- Peter M. Pollak, MDa,
- Firas Barrow, MDb,
- Joseph F. Malouf, MDa,
- Rick A. Nishimura, MDa,
- Lyle D. Joyce, MD, PhDa,
- Joseph A. Dearani, MDa and
- Charanjit S. Rihal, MD, MBAa,∗ ()
- aDepartment of Cardiovascular Diseases and Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
- bDivision of Cardiovascular Diseases, New York University Medical Center, New York, New York
- cDivision of Cardiovascular Diseases, Intermountain Heart Institute, Salt Lake City, Utah
- dDivision of Cardiovascular Diseases, University of Alabama, Birmingham, Alabama
- eDivision of Cardiovascular Diseases, St. Michael’s Hospital, Toronto, Ontario, Canada
- ↵∗Reprint requests and correspondence:
Dr. Charanjit S. Rihal, Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, Minnesota 55905.
Objectives This study sought to examine the feasibility, safety, and intermediate-term outcomes in patients undergoing percutaneous transvenous transcatheter mitral valve implantation in failed bioprosthesis, ring annuloplasty, and calcific mitral stenosis.
Background Surgical mitral valve replacement in patients with previous surgery or severe mitral annular calcification (MAC) is often associated with high or prohibitive risk.
Methods Percutaneous transfemoral antegrade transseptal implantation of Edwards SAPIEN prosthesis (Edwards Lifesciences, Irvine, California) was performed in 48 patients with degenerated mitral bioprosthesis (n = 33), previous ring annuloplasty (n = 9), and severe MAC (n = 6).
Results The mean Society of Thoracic Surgeons risk score was 13.2 ± 7.4% with a mean age 76 ± 11 years. Acute procedural success was achieved in 42 of 48 patients (88%) in the overall group and 31 of 33 (94%) in the failed bioprosthetic mitral valve group and success rate of 11 of 15 (73%) in patients with failed annuloplasty rings and MAC. After successful procedure, no patients had > mild residual mitral prosthetic or periprosthetic regurgitation; mean transvalvular gradients were 6 ± 2.5 mm Hg. Thirty-day survival free of death and cardiovascular surgery was 85% in the overall group and 91% in the failed bioprosthetic mitral valve subgroup.
Conclusions Transfemoral percutaneous transvenous mitral valve implantation in high-risk patients with degenerated bioprosthesis is safe, effective, and associated with rapid improvement in hemodynamics, short length of stays, and improved functional status. Percutaneous mitral valve implantation in patients with failed annuloplasty rings and severe MAC is a promising therapy with significant short-term morbidity and mortality that requires further study.
Dr. Williams has served as a consultant for Edwards Lifesciences; and has received research funding from Medtronic. Dr. Whisenant has served as a consultant for Edwards Lifesciences and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 9, 2015.
- Revision received January 29, 2016.
- Accepted February 25, 2016.
- American College of Cardiology Foundation