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International Society For Minimally Invasive Cardiothoracic Surgery

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Outcomes of Transcatheter Simultaneous Mitral and Aortic Valve in Valve Procedure
Marieluise Harrer, Stefanie Wallner, Andreas Strouhal, Martin Grabenwoeger, Reinhard Moidl
Klinik Floridsdorf, Vienna, Austria

BACKGROUND:Patients with the need of reoperation after double valve disease due to degenerated bioprotheses, are at high surgical risk. Transapical transcatheter mitral and aortic valve implantation without cardiopulmonary bypass is an alternative procedure for patients with this prohibitive surgical risk.
METHODS: Four patients underwent transapical simultaneous transcatheter valve-in-valve aortic and mitral procedure (TAVI-VIV and TMVI-VIV) with balloon-expandable aortic valves (mean age = 75.2 4.5 years, mean log EuroScore I = 23.5 10.8, mean log. EuroScore II = 17.1 7.8). For mitral prostheses always size 29 was used, in contrast in the aortic position size 23, 29 and 26 in two patients. Mean time from first double valve operation to TAVI-VIV was 9.81.5 years, range 8-13. Additionally, two patients underwent CABP before the first surgical double valve replacement; the other two patients had PTCA before TAVI-VIV procedure. RESULTS: Overall technical success rate was 100%. No patients died in hospital (mortality = 0%) or at follow-up (cumulative follow-up = 59 month). No valvular or paravalvular regurgitation was observed. Peak gradient (mmHg) after implantation was 6.21.6 in mitral and 19.93.2 in aortic prostheses, showed excellent haemodynamic performances. However, in one patients a re-thoracotomy due to diffus bleeding from the mini-thoracotomy was necessary. CONCLUSIONS:Simultaneous TMVI-VIV and TAVI-VIV in an experienced transcatheter valve implantation department, is a safe procedure. Especially in such patients with high surgical risk, the transcatheter procedure via transapical access shows low adverse events with excellent haemodynamic results.


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