Screen Passed And Failed Patients For Transcatheter Mitral Valve Implantation.
Gry Dahle, Thomas Helle-Valle, Jan Otto Beitnes, Andreas Espinoza, Per Steinar Halvorsen, Kjell Arne Rein.
Rikshospitalet, OUS, Oslo, Norway.
OBJECTIVES: Transcatheter mitral valve replacement has recently been introduced as an alternative treatment option for severe mitral regurgitation. We present our single-centre first experience with screening and implantation outcomes. METHODS: Thirty five patients with mitral regurgitation grades 3 and 4 were screened based on study inclusion/exclusion criteria, echo- cardiography and computed tomography imaging. All patients were evaluated by the centre’s Heart Team, followed by the catheter valve companies’ internal screening process. Patients who failed the screening criteria were considered for alternative treatments. RESULTS: Of the 35 patients screened for transcatheter mitral valve replacement, 21 patients failed screening and 14 patients passed. The patients who failed screening were more often older, were women and were smaller in stature than those who passed screening. The main reason for patients to fail screening changed during the study from large annular dimensions to a small predicted neo-left ventricular outflow tract. Ten of the 14 patients who passed screening were treated using the transcatheter mitral valve device, and 4 patients required alternate treatments due to urgency including MitraClip procedure and surgical repairs. Of the 21 patients who failed the screening, 5 patients had open surgery (4 patients received mitral valve repair and 1 mitral valve replacement). All 10 patients who underwent the transcatheter mitral valve procedure were successfully treated without mortality during the observation time (6-40 months). One patient with arrhythmogenic right ventricle cardiomyopathy underwent heart transplant 10 months post procedurally. On examining the explanted heart, the valve was perfectly seated and “integrated” in the heart. CONCLUSIONS: Transcatheter mitral valve replacement is an effective and safe treatment for well-selected patients with symptomatic mitral regurgitation. For patients who fail the screening process, transcatheter repair or open surgical valve repair are feasible.
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