AI Article Synopsis
- This study focused on the clinical and echocardiographic outcomes of transapical mitral valve-in-valve (VIV) replacement in high-risk patients with failed bioprostheses.
- Eleven patients, with an average age of 63.7 years and significant surgical risk, underwent successful VIV implantation using various valve types, achieving low levels of mitral regurgitation post-procedure.
- Over a four-year follow-up, there was a notable improvement in the patients' heart function, with a high survival rate, though one patient did experience multiorgan failure shortly after the procedure.
Article Abstract
Objective: This study is a report of clinical and echocardiographic outcomes of experience with transapical mitral valve-in-valve (VIV) replacement.
Methods: Eleven patients with a mean age of 63.7±13.0 years who underwent transapical mitral VIV implantation for a failed bioprosthesis at a single institution were enrolled. All of the patients were considered high-risk for surgical intervention, with a Society of Thoracic Surgery predicted risk of mortality of 14.2±17.6%, and a mean European System for Cardiac Operative Risk Evaluation (EuroSCORE II) of 10.5±6.1%.
Results: Transapical mitral VIV implantation was successful in all of the patients. Edwards, Sapien XT and Sapien 3 valves (Edwards Lifesciences Corp., Irvine, CA, USA) were used in 8 (73%), 2 (18%), and 1 (9%) patients, respectively. Size 26 valves were used in 6 (55%) patients while size 29 valves were used in 5 (45%) patients. All of the patients (11, 100%) had no or only trace mitral regurgitation at the end of the procedure. The mean length of hospital stay was 19±8.0 days. The survival was 100% at 14 days, and 90% at 30 days and at 4 years. One patient died as a result of multiorgan failure on day 16 of intensive care unit stay. The mean mitral valve gradient across the percutaneous valve was 2.26±1.047 mmHg, and the mean valve area was 2.20±0.14 cm2. Through the 4 years follow up, the New York Heart Association class of the 10 patients remaining improved to class II with no readmission for heart failure. All of the patients were on coumadin with a target international normalized ratio of 2-3.
Conclusion: In high-risk patients, transapical mitral VIV implantation can be performed with a high success rate and considerable improvement in clinical status.
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| http://dx.doi.org/10.5543/tkda.2020.07893 | DOI Listing |
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