Mitral valve implantation effective for degenerated bioprosthetic mitral valve

Last Updated: 2016-04-28

By Reuters Staff

NEW YORK (Reuters Health) - High-risk patients with failed bioprosthetic mitral valve, previous ring annuloplasty, or severe calcific mitral stenosis can be treated effectively with percutaneous transvenous transseptal mitral valve implantation, researchers report.

Up to 35% of patients with mitral valve replacement or repair require reoperation in the ensuing 10 years, and repeat surgery can be associated with high mortality.

Dr. Charanjit S. Rihal from Mayo Clinic, Rochester, Minnesota, and colleagues evaluated the outcomes of percutaneous antegrade transvenous transseptal mitral valve implantation using the recently commercially available SAPIEN valve in 48 patients with failed mitral bioprosthesis (n=33), ring annuloplasty (n=9), and mitral stenosis due to severe mitral annular calcification (MAC) (n=6).

Percutaneous transseptal implantation was successful in 31 patients (94%) with failed bioprosthetic valves, seven patients (78%) with failed annuloplasty rings, and four patients (67%) with severe MAC, according to the April 13 JACC Cardiovascular Interventions online report.

Two patients with failed bioprosthesis died during valve deployment, two cases with failed annuloplasty rings were complicated by valve migration into the left atrium, and two cases with severe MAC experienced cardiac tamponade and severe regurgitation of the initially deployed valve.

Procedural changes during the learning curve resulted in higher rates of procedural success, lower rates of complications, and shorter total procedure duration.

Thirty-day survival free of cardiovascular surgery was 85% overall and 91% in the failed bioprosthetic mitral valve subgroup.

All but three of the 37 patients who reached 30 days of follow-up experienced significant improvements in functional status and reported New York Heart Association class 1-2 symptoms. Five patients so far have maintained these improvements at one-year follow-up.

"Percutaneous antegrade transvenous mitral valve implantation in failed surgical prostheses is a minimally invasive, feasible, and highly effective treatment for either prosthetic stenosis or regurgitation," the researchers conclude.

"Early and mid-term outcomes are excellent in patients undergoing successful transvenous mitral valve in valve, and further study of long-term outcome data is required. Percutaneous mitral valve implantation in patients with failed annuloplasty rings and mitral stenosis due to MAC shows promise but has significant challenges that require further study," they add.

Dr. Rihal did not respond to a request for comments.

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/1SC7Jx5

JACC Cardiovasc Interv 2016.