Back to 2016 Annual Meeting Cardiac Track

OBJECTIVE: In our cardiac surgical practice of complex mitral valve patients, we are faced with a small cohort of prohibitively high-risk patients. We have treated these patients with catheter-based interventions using a heart-team approach led by cardiac surgeons. Broadly, two generic types of devices have been used for mitral valve pathologies; devices designed specifically for the mitral valve or those devised originally for the aortic position but adapted to the mitral. Our experience with these therapies include first-in-man transapical mitral valve implants (TMVI) of an apically tethered device (Tendyne) and transcatheter valve implant of aortic prostheses (Edwards Sapien and Direct Flow) in the mitral position. We report our initial experience.
METHODS: Between March2013 and December2015, a total of 13 patients were treated with novel TCV therapies. Of these, 4 patients had native mitral valve disease and underwent TMVI with the Tendyne prosthesis. A further 9 patients had undergone previous mitral valve surgery of whom 4 had failing mitral bioprostheses and 5 had recurrent MR following mitral repair. All patients had MR grade 4 and severe pulmonary hypertension. In this group, Valve in Valve (ViV) or Valve in Ring (ViR) implantation was carried out in 6 patients with the Edwards Sapien system, two with Direct Flow and one with Tendyne TMVI.
RESULTS: Device success was achieved in all patients. There were no procedural complications, no valve malpositioning or embolization and no access site complications. No patient had residual significant MR or significant mitral gradient. There was no 30 day mortality or CVA. All patients were discharged to their own home. At 6 month follow up, all (N=7) patients were alive and with significant improvement of their functional capacity.
CONCLUSIONS: An armamentarium of TCV options is required in surgical centres to be able to treat the full range of mitral valve pathologies. In our experience, a high risk group of patients can be treated successfully with low morbidity and mortality using these novel therapies.

Age at Intervention	MV pathology	Previous Surgery	Type of Device	Device Size
77	MR	MVR, 31mm Carpentier-Edwards	Sapien XT	29
68	MR	MVR, 29mm Carpentier-Edwards	Sapien XT	29
84	MR	MVR, 29mm Medtronic Mosaic	Sapien XT	26
52	MS+MR	MV Repair, 32mm CE Physio Ring,	Sapien XT	29
83	MR+MS	MVR, 27mm Aspire	Sapien XT	26
33	MS+MR	MV Repair, 26mm CE Physio Ring	Sapien XT	23
66	MR	MV Repair, 28mm McCarthy Adams,	Direct Flow	23
71	MR	MV Repair, 34mm CE Physio Ring,	Direct Flow	27
68	MR	CABG	Tendyne	32.5x34.5
75	MR	CABG	Tendyne	34.5x48.5
88	MR	NA	Tendyne	32.5x43.5
74	MR	MV Repair, 38 mm CE Physio Ring	Tendyne	32.5x34.5
63	MR	NA	Tendyne	40.5x47.5