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- Title
Valve-in-valve transcatheter transfemoral mitral valve implantation (ViV-TMVI): Characteristics and early results from a nationwide registry.
- Authors
Huczek, Zenon; Mazurek, Maciej; Kochman, Janusz; Kralisz, Paweł; Jagielak, Dariusz; Sacha, Jerzy; Frank, Marek; Targoński, Radosław; Walczak, Andrzej; Rymuza, Bartosz; Grodecki, Kajetan; Scisło, Piotr; Jędrzejczyk, Szymon; Jańczak, Jakub; Pysz, Piotr; Rudziński, Piotr Nikodem; Demkow, Marcin; Witkowski, Adam; Grygier, Marek; Wojakowski, Wojciech
- Abstract
Background: Valve-in-valve transcatheter transfemoral mitral valve implantation (ViV-TMVI) is an emerging treatment alternative to reoperation in high-surgical risk patients with failed mitral bioprostheses. Aim: We aimed to describe the characteristics of ViV-TMVI and evaluate its 30-day outcomes in the Polish population. Methods: A nationwide registry was initiated to collect data on all patients with failed mitral bioprosthesis undergoing ViV-TMVI in Poland. This study presents the results of a 30-day clinical and echocardiographic follow-up. Results: Overall, 27 ViV-TMVI procedures were performed in 8 centers up to May 2022 (85% from 2020 onwards). The mean (standard deviation [SD]) age was 73 (11.6) years with the median (interquartile range [IQR]) Society of Thoracic Surgeons score of 5.3% (4.3%–14.3%). Mean (SD) time between surgical implantation and ViV-TMVI was 8.2 (3.2)years. Failed Hancock II (29%) and Perimount Magna (22%) bioprostheses were most frequently treated. Mechanisms of failure were equally often pure mitral regurgitation or stenosis (both 37%) with mixed etiology in 26%. Balloon-expandable Sapien 3/Ultra valves were used in all but 1 patient. Technical success was 96.3% (1 patient required additional prosthesis). Mean (SD) transvalvular mitral gradient reached 6.7 (2.2) mm Hg and mitral valve area was 1.8 (0.4) cm². None of the patients had moderate or severe mitral regurgitation with only 14.8% graded as mild. We achieved device success in 92.6% of patients (2 patients had mean gradient ≥10 mm Hg) and procedural success in 85.6%. There were no deaths, cerebrovascular events, or need for mitral valve surgery during the 30-day follow-up. Conclusions: In short-term follow-up, ViV-TMVI is a safe and effective alternative for patients with failed mitral bioprosthesis at high surgical risk of re-operation. Longer observations on larger samples are warranted.
- Subjects
POLAND; RISK of prosthesis complications; MITRAL valve transplantation; CARDIAC catheterization; CARDIAC surgery; SURGICAL complications; RISK assessment; TREATMENT effectiveness; PROSTHETIC heart valves; REOPERATION; DESCRIPTIVE statistics; VENTRICULAR outflow obstruction; DISEASE risk factors
- Publication
Polish Heart Journal / Kardiologia Polska, 2023, Vol 81, Issue 6, p606
- ISSN
0022-9032
- Publication type
Article
- DOI
10.33963/KP.a2023.0094