Transcatheter Mitral Valve Implantation in Patients with Mitral Annular Calcification and a Former Aortic Valve Implantation
Gry Dahle, Kjell Arne Rein.
Rikshospitalet, Ous, Oslo, Norway
BACKGROUND: Transcatheter mitral valve implantation (TMVI) has recently emerged as a treatment option for selected high risk patients with symptomatic mitral regurgitation and sometimes mitral annular calcification (MAC). The feasibility of TMVI in patients with previous aortic valve prosthesis, either AVR or TAVI is published by Taramasso et al 2020. There are also reports on TMVI in MAC described by Sorajja et al 2019. We present three patients with previous aortic valve prosthesis, two with TAVI and one SAVR, two of them had MAC. METHODS: Three , one female, mean age 72 years, with significant comorbidity and prior aortic valve replacement (mechanical size 23))/TAVI (self-expandable size 26 and 29) were referred to TMVI due to mitral regurgitation, two with combined stenosis. All of them had pacemaker implanted.CT reconstruction was done, and anatomical conditions were acceptable. For one patient the reconstruction was initially done with the CT scan pre TAVI and neoLVOT was found too small. A new CT scan was performed and reconstructed. Following TAVI the neoLVOT became big enough to provide a transcatheter mitral valve prosthesis.The procedure was performed in general anesthesia with echo and fluoro guidance, balloon valvuloplasty was performed prior to the valve implantation in one case. A self-expandable mitral valve secured with an apical tether was used. RESULTS: All the patients had a successful mitral valve implantation with no paravalvular leakage and a minimal transvalvular mitral pressure gradient with no increase in the LVOT extraction gradient. Post-procedural CT-scan documents valve positions and echo showed good valve performance. 30 day survival was 100%. One patient had cerebral stroke 2 months post-procedural, probably due to non-compliance on anticoagulation. One patient died from new lymphoma 19 months post-procedural. CONCLUSIONS:TMVI is feasible in patients with prior aortic valve prosthesis, even in MAC. This may be a safe solution for selected high risk patients instead of open redo surgery. 