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Clinical Results with Transapical Mitral Valve Implantation in Native Mitral Valve
Anson Cheung, Stefan Verheye, John Webb, Robert Moss, Jonathan Leipsic, Shmuel Banai.
St. Paul's Hospital, Vancouver, BC, Canada.

Objective: Mitral valve surgery remains the treatment of choice for MR. Risk of surgery remains high in the elderly with comorbidities and poor left ventricular function. Catheter-based mitral valve implantation technology has been developed and may become a viable option for some selected patients with severe symptomatic MR.
Methods: The Tiara mitral prosthesis is a nitinol based, self-expanding, trileaflets valve that fits the D-shaped native mitral annulus. Four patients with symptomatic severe MR were assessed by the Heart Team and deemed too high risk for conventional MV surgery and under Canadian Special Access received the implants . Implants were carried out via a left mini-thoracotomy, transapically with transesophageal and fluoroscopic guidance.
Results: Four patients with a mean age of 62 years, with mean LVEF of 24 ± 8% ,LVEDD of 75 ± 14mm and severe MR underwent uneventful implantation of the Tiara valve on a beating heart. All, but one patient was extubated in the operating room. No intraoperative event and no transfusion were required. Echocardiograms demonstrated excellent prosthetic valve function with a low transvalvular gradient and no left ventricular outflow tract obstruction. There was trivial paravalvular leak (PVL) in 1 patient which was resolved at follow-up. No PVL was detected in the other patients. First patient with multiple comorbidities died 69 post-implant. All other patients are alive and in NYHA II and III with a mean follow-up of 150 days. No other device related event was encountered.
Conclusions: Transapical transcatheter mitral valve implantation with the Tiara device is technically feasible and can be performed safely. Device functions and performance is excellent. Early clinical outcome is positive. Catheter based mitral valve implantation will become a treatment option in the future.

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