Background: Mitral valve replacement in the setting of severe mitral annular calcification remains a surgical challenge. Transcatheter mitral valve replacement (TMVR) using an aortic balloon-expandable transcatheter heart valve is emerging as a potential treatment option for high surgical risk patients. Transseptal, transapical, or transatrial access is not always feasible, so an understanding of alternative implantation techniques is important. Objectives: The authors sought to present a step-by-step description of a contemporary transatrial TMVR technique using balloon-expandable aortic transcatheter heart valves. This procedure has evolved over time to address valve migration, left ventricular outflow tract obstruction, and paravalvular leak. The authors present a refined technique that has been associated with the most reproducible outcomes. Methods: A step-by-step description of the TMVR technique and outcomes of 8 patients treated using this technique are described. Baseline patient clinical and echocardiographic characteristics and 30-day post-TMVR outcomes are presented. Results: Eight patients underwent transatrial TMVR at a single institution. Five had previous cardiac surgery. Mean STS score was 8%. Technical success by MVARC (Mitral Valve Academic Research Consortium) criteria was 100%. There was zero in-hospital and 30-day mortality. Procedural success by MVARC criteria at 30 days was 100%. Paravalvular leak immediately post-implant was none or trace in 6 and mild in 1. Conclusions: The technique described is reproducible and was associated with favorable outcomes in this early experience. It represents a useful technique for the treatment of mitral valve disease in the setting of severe annular calcification. A structured and defined implantation technique is critical to investigators as this field evolves.
Bibliographical noteFunding Information:
Dr. Guerrero has received research funding from and been a proctor for Edwards Lifesciences. Dr. Salinger has been a consultant for Edwards Lifesciences and Boston Scientific; and a proctor for Edwards Lifesciences. Dr. Wang has been a consultant for Edwards Lifesciences, Boston Scientific, and Materialise; and is a co-inventor on a patent application assigned to Henry Ford Health System for software prediction of LVOT obstruction. Dr. Sakhuja has been a consultant/proctor for Edwards Lifesciences and Medtronic. Dr. Fang has been a consultant for Edwards Lifesciences. Dr. Tang has been a proctor for Edwards Lifesciences. Dr. Feldman has received research funding from and been a consultant for Edwards Lifesciences, Abbott, and Boston Scientific. Dr. Bapat has been a consultant for and received speaker fees from Edward Lifesciences and Medtronic. Dr. George has been a consultant for Edwards Lifesciences, Medtronic, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
© 2018 American College of Cardiology Foundation
- mitral annular calcification
- valve replacement