Back to Annual Meeting Program
First in man implantation of transapical 29 mm Edwards Sapien™ aortic valve in a failed mitral valve repair with a 34 mm annuloplasty ring.
Gry Dahle, Arnt Fiane, Hilde Korslund, Kjell Arne Rein.
Rikshospitalet, OUS, Oslo, Norway.
Objective Mitral valve repair with annuloplasty ring is the treatment of choice for mitral regurgitation, but recurrency may occur, necessitating re-intervention. The operative risk at re-operation is significantly higher than in the primary operation. It is previously demonstrated that a trans-catheter valve-in-valve technique reduces the operative risk. Though, the experience with valve-in-ring procedure is limited, we demonstrate the use of a transapical 29mm Edwards Sapien™ aortic valve in a failed mitral valve repair with a 34mm Edwards Physio® semi-rigid ring.
Methods A 71 years old female underwent both mitral- and tricuspid valve repair with implantation of annuloplasty rings three years before referral. The operative result was initially good, but she developed residual mitral regurgitation and heart failure (EF17), NYHA III-IV and declive oedema. She was deemed to have too high operative risk for conventional redo surgery. We measured the Physio®-ring inner diameter on 3D-transoesophageal echo and CT scan and correlated this to the company spesifications. We tried the 34mm Physio®-ring on different Carbomedics® aortic sizers, fitting the 27mm sizer. In a ”bench-test” we expanded a 29mm Edwards Sapien™ valve into a 34mm Physio®-ring.
Following these test the patient underwent a transapical mital valve-in-ring implantation on partial cardio-pulmonary bypass. She got electrodes for planned cardiac re-synchronization therapy.
Results The 29mm Edwards Sapien™ valve fitted well into the 34mm Physio®-ring. Postoperative the patient had only a small paravalvular leak, otherwise the valve functioned well. IABP was used for 24hrs, otherwise the postoperative periode was uneventful.
Conclusion The valve-in-ring concept may play an important role in the future to reduce the redo-mortality in patients with failed mitral valve repair. The 26mm Edwards Sapien™ valve has previously been used in a 28mm Physio®-ring. We have shown that it is feasible to put a 29 mm Edwards Sapien™ valve in a 34mm Physio®-ring. This is of great importance as many Pysio®-semirigid rings of the size 30 - 34mm are used in repairing degenerative mitral valve disease.
Back to Annual Meeting Program