Mitral Valve-in-valve And Valve-in-ring Implantation Using A Fully Repositionable Transcatheter Valve System
Arnaud Van Linden, Won-Keun Kim, Mani Arsalan, Matthias Renker, Christoph Liebetrau, Florian Hecker, Ulrich Fischer-Rasokat, Thomas Walther.
Kerckhoff Klinik, Bad Nauheim, Germany.
OBJECTIVE: Transcatheter mitral valve-in-valve (ViV) or valve-in-ring (ViR) implantations are minimally invasive alternative treatment options in higher risk patients. The individual patients’ anatomy must be evaluated, especially to minimize the risk of left ventricular outflow tract (LVOT) obstruction during these procedures. We evaluated the feasibility of a fully repositionable transcatheter valve system (Lotus™, Boston Scientific), which allows for retrieval after hemodynamic measurements, in the mitral position.
METHODS: Between January and December 2016, four patients with prior mitral valve repair and three patients with prior mitral valve replacement were treated using the Lotus valve system. All patients were at high risk for redo surgery with mean STS-score, logistic EuroSCORE and EuroSCORE II of 10.9±6, 27.4±8 and 14.4±7.6%, respectively. Mean age was 80±4 years, 5 patients underwent their third and 2 patients their second cardiac operation.
RESULTS: Hemodynamic measurement consisted of simultaneous left ventricular and aortic root pressure tracings. Lotus valve implantation was successfully performed in all patients. Hemodynamic measurement revealed absence of LVOT obstruction in 6 patients. In 1 patient, however, even after repositioning of the valve, a relevant LVOT gradient was observed. The transcatheter valve was retrieved and the patient underwent redo surgery one week later. There was no mortality and all patients were discharged in significantly improved conditions (NYHA functional class I or II). Mean transprosthetic gradient was 6±1.5 mmHg and there was no paravalvular leak in 5 patients. One patient had a paravalvular leak 1° at discharge and 2° at 2-month follow-up. This patient underwent re-redo mitral valve replacement and was discharged in good clinical condition.
CONCLUSIONS: The repositionable and retrievable Lotus valve system can be safely used for the treatment of degenerated mitral valve xenografts and failed mitral valve repair. The unique opportunity of full valve deployment and still full retrievability, allows for complete hemodynamic evaluation to avoid LVOT obstruction uring the implantation.
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