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Implantation In Surgical Bio-prosthetic Valve Fracture For Optimizing Hemodynamics
Attaullah K. Niazi¹, Mohammed Sharif Nassery²;
¹King edward medical university, Lahore, Pakistan, ²French medical institute for mothers and children, Kabul, Pakistan

BACKGROUND:

A 72 years old man who is wheelchair-bound due to NYHA class III symptoms comes with clinical signs of heart failure.

Past medical history:

Aortic root replacement with bio-prosthetic AVR (2015). Alfieri repair of the mitral valve with postoperative moderate-severe residual regurgitation. Asthma Permanent Atrial fibrillation Amiodarone induced thyroid dysfunction Obstructive sleep apnea

Trans-esophageal echo was done which showed: ➢Severe mitral regurgitation secondary to P2/P3 prolapse ➢Mild left ventricular impairment in the context of severe mitral

regurgitation

➢Ejection fraction = 50% ➢Well-seated bio-prosthetic aortic valve with normal function ➢MV mean gradient <2mmHg ➢Suitable anatomy for mitral TEER

METHODS:
Procedural details

Day-case procedure General anesthetic/trans-esophageal

echo guided

Device: Pascal ACE (Edward Lifesciences) Access: 11F right femoral vein, pre-closed

with 2 x-proglides

Trans-septal puncture positioned

mid-posterior septum

The implant positioned medial to Alfieri

stitch (over-dominant jet)
RESULTS:

Stable device position
Mild residual MR Mitral valve mean gradient

unchanged (<3mmHg)
CONCLUSIONS:
Learning points:

This case highlights the differences between the Alfieri

procedure versus the trans-catheter edge to edge repair:

Ability to check the final result in TEER before the end of the procedure under

hemodynamically normal conditions

Can try multiple positions of the device and optimize the leaflet grasp to

get the best possible results

Demonstrate maneuverability of the Pascal device in

challenging anatomy

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