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Transcatheter mitral valve implantation

Shumpei Mori, Justin T Tretter, Takayoshi Toba, Yu Izawa, Natsuko Tahara, Tatsuya Nishii, Shinsuke Shimoyama, Hidekazu Tanaka, Toshiro Shinke, Ken-Ichi Hirata, Diane E Spicer, Farhood Saremi, Robert H Anderson
Introduction Knowledge of the anatomy of the membranous septum, as a surrogate to the location of the atrioventricular conduction axis, is a prerequisite for those undertaking transcatheter implantation of the aortic valve (TAVI). Equally important is its relationship of the virtual basal ring. This feature, however, has yet to be adequately described in the living heart. Materials and Methods We analyzed computed tomographic angiographic datasets from 107 candidates (84.1 ± 5.2 years, 68% women) for TAVI...
March 15, 2018: Clinical Anatomy
Toshinari Onishi, Kaoruko Sengoku, Yasuhiro Ichibori, Isamu Mizote, Koichi Maeda, Toru Kuratani, Yoshiki Sawa, Yasushi Sakata
Transcatheter aortic valve implantation (TAVI) is an effective and less invasive treatment for the increasing population of individuals with severe aortic stenosis (AS). Echocardiography is crucial in the assessment of AS patients from pre- to post-procedure. Transthoracic echocardiography (TTE) may be used to assess patient suitability for TAVI, as well as evaluate the severity of AS, the aortic valve complex, aortic valve morphology, mitral regurgitation (MR), and left ventricular function. Transesophageal echocardiography (TEE) is usually used as an intra-procedural monitoring tool to provide feedback during the procedure, to assess prosthetic valve function, and to detect complications rapidly before and after balloon aortic valvuloplasty (BAV) or transcatheter heart valve (THV) deployment...
February 2018: Cardiovascular Diagnosis and Therapy
Enrico Ferrari, Luigi Biasco, Francesco Faletra, Anson Cheung, Marco Moccetti, Giovanni Pedrazzini, Stefanos Demertzis, Tiziano Moccetti
Transcatheter mitral valve replacement with the TiaraTM valve can be performed in inoperable patients with severe functional regurgitation. Risk of left ventricular outflow tract obstruction can be prevented using preoperative 3D-imaging and 3D-printed models. However, in case of mono-disk mechanical prosthesis previously implanted in aortic position (Bjork-Shiley) there is an additional risk of mechanical interference leading to reduced leaflet motion and aortic valve dysfunction. Hereafter, we describe the case of a patient with a 27mm mono-disk mechanical aortic valve implanted in 1978, Euroscore-II of 18% and STS-score (mortality) of 16% who successfully underwent a transapical TiaraTM valve implantation...
March 5, 2018: Seminars in Thoracic and Cardiovascular Surgery
Zouhair Rahhab, Ben Ren, Peter P T de Jaegere, Nicolas M D A Van Mieghem
No abstract text is available yet for this article.
March 6, 2018: European Heart Journal
Masahide Komagamine, Nobuyuki Furukawa, Jan Gummert, Jochen Börgermann
Transapical transcatheter aortic valve implantation is a well-established alternative in patients at a high risk for conventional aortic valve replacement. We performed transapical transcatheter aortic valve implantation on an 83-year-old woman with symptomatic severe aortic stenosis. Intraoperative transoesophageal echocardiography (TOE) after transcatheter aortic valve implantation showed mild mitral regurgitation without intracardiac structural injury. In the intensive care unit, the patient gradually had haemodynamic instability; TOE revealed severe mitral regurgitation with A2 and A3 prolapse due to rupture of the posterior papillary muscle...
March 5, 2018: European Journal of Cardio-thoracic Surgery
Sivasankaran Sivasubramonian, Arun Gopalakrishnan, Bijulal Sasidharan, Ajitkumar Valaparambil
Transient elevation of LV diastolic pressure above LA pressure can occur in severe aortic regurgitation in the diastasis phase. Mitral E wave reversal in such a situation could serve as non-invasive evidence of elevated left ventricular diastolic pressures, thereby guiding therapeutic decision making.
March 2018: Journal of Invasive Cardiology
Mitsunobu Kitamura, Tobias Schmidt, Karl-Heinz Kuck, Christian Frerker
PURPOSE OF REVIEW: Interventional techniques have been developed for a wide spectrum of mechanisms of heart failure (HF), especially in valvular heart disease and cardiomyopathies (ischaemic cardiomyopathy and hypertrophic cardiomyopathy). In this article, we review recent reports on catheter interventions to treat patients with HF. RECENT FINDINGS: Direct modification using the Parachute device and the REVIVENT-TC device for patients with impaired left ventricle with large infarct scars improves geometry and haemodynamic efficiency, resulting in a reduction of HF symptoms...
February 12, 2018: Current Cardiology Reports
Nicholas S Clarke, Howaida El-Said, John J Lamberti, Raghav A Murthy
Percutaneous therapies for congenital heart disease have been evolving rapidly despite limited investment from industry. The Melody transcatheter pulmonary valve (Medtronic, Inc, Minneapolis, MN USA) replacement therapy represents an important advancement in this arena. It has been approved in the United States for use in the pulmonary position, on a Humanitarian Device Exemption status. Off-label use of the Melody transcatheter pulmonary valve has extended to the mitral, pulmonary, and aortic valves, especially in previously implanted valves with prosthetic valve degeneration...
January 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Adham Elmously, Berhane Worku, Katherine D Gray, Arash Salemi
BACKGROUND: Transapical transcatheter mitral valve-in-valve implantation (TA-MVIVI) for bioprosthetic valve failure is an emerging alternative to re-operation in high risk patients. We report our outcomes in a patient population with a high proportion of cardiogenic shock. METHODS: Retrospective review was performed of all patients undergoing TA-MVIVI with an Edwards SAPIEN (Edwards Life sciences, Irvine, CA) prosthesis at our center between the years of 2013-2017...
January 27, 2018: Annals of Thoracic Surgery
Klaas Loger, Saskia Pokorny, Tim Schaller, Irma Haben, Derk Frank, Georg Lutter
OBJECTIVES: In this study, results of a functional in vitro study of 2 newly developed valved stents for transcatheter mitral valve implantation are presented. METHODS: Two novel stent designs, an oval-shaped and a D-shaped stent with a strut fixation system were developed. The fixation force of the novel stents were tested in vitro in porcine hearts with a tensile test set-up. In further experiments, the stents were equipped with a circular valved stent, and the valve performances were investigated in a pulsatile heart valve tester...
February 1, 2018: Interactive Cardiovascular and Thoracic Surgery
Ignacio J Amat-Santos, Paol Rojas, Peter R Stella, Luis Nombela-Franco, Roman Lezáun-Burgui, Antonio J Muñoz-García, Vicenç Serra, Enrique Gutierrez-Ibanes, Mariano Larman, Ramón Rodriguez-Olivares, Nynke H M Kooistra, Hipólito Gutiérrez, José A San Román
AIMS: To describe the incidence, mechanisms, management and outcomes of intracardiac shunts (ICS) following TAVI. METHODS AND RESULTS: Multicentre registry across 10 centres aimed to gather all cases of ICS (1.1%) including infection-related (IRICS, 0.3%) or aseptic (AICS, 0.8%) shunts. Patients presented porcelain aorta (24% vs. 6.8%, p=0.024) and had been treated with pre- (88% vs. 68.5%, p=0.037) or post-dilation (59.1% vs. 19.3%, p<0.001) more often. Median time from intervention to diagnosis of ICS was 10 days [IQR: 2-108], being longer for IRICS (171 [63-249] vs...
January 23, 2018: EuroIntervention
Hikaru Tsuruta, Kentaro Hayashida, Fumiaki Yashima, Ryo Yanagisawa, Makoto Tanaka, Takahide Arai, Yugo Minakata, Yuji Itabashi, Mitsushige Murata, Shun Kohsaka, Yuichiro Maekawa, Tatsuo Takahashi, Akihiro Yoshitake, Hideyuki Shimizu, Keiichi Fukuda
OBJECTIVES: We aimed to evaluate the incidence and midterm clinical outcomes of left ventricular obstruction (LVO) after transcatheter aortic valve implantation (TAVI). BACKGROUNDS: LVO is occasionally unmasked following valve replacement for severe aortic stenosis. However, little is known about the prevalence and effects of LVO after TAVI. METHODS: A total of 158 patients who underwent TAVI in our center between October 2013 and November 2015 received echocardiographic evaluations at baseline; before hospital discharge; and at 3, 6, and 12 months after TAVI...
January 23, 2018: Catheterization and Cardiovascular Interventions
Jeremy J Thaden, Joseph F Malouf, Vuyisile T Nkomo, Sorin V Pislaru, David R Holmes, Guy S Reeder, Charanjit S Rihal, Mackram F Eleid
BACKGROUND: Mitral regurgitation is a heterogeneous disease. Determining which patients derive optimal outcomes from transcatheter edge-to-edge mitral valve repair (TMVR) remains challenging. We sought to determine whether baseline mitral valve anatomic characteristics are predictive of left atrial pressure (LAP) changes during TMVR with MitraClip. METHODS AND RESULTS: Consecutive patients with severe mitral regurgitation undergoing TMVR (n=112) underwent continuous intraprocedural LAP monitoring and retrospective echocardiographic analysis for specific mitral anatomic characteristics...
January 13, 2018: Journal of the American Heart Association
Gialama Fotini, Prezerakos Panagiotis, Apostolopoulos Vasilis, Nikolaos Maniadakis
Objectives: Transcatheter aortic valve implantation (TAVI) and transcatheter mitral valve repair (TMVR) are increasingly used for managing patients with valvular heart disease to whom surgery presents a high-risk. As these are costly procedures, a systematic review of studies concerned with their economic assessment was undertaken. Methods: The search was performed in PubMed and the Cochrane Library and followed recommended methodological steps. Studies were screened and their data were retrieved and were synthesized using a narrative approach...
January 9, 2018: European Heart Journal. Quality of Care & Clinical Outcomes
Sabato Sorrentino, Gennaro Giustino, Kamilia Moalem, Ciro Indolfi, Roxana Mehran, George D Dangas
Transcatheter heart valve replacement technology was introduced as alternative to surgery for the growing high-risk profile population. Developed first, aortic valve replacement (TAVR) became a standard of care for patients with severe aortic stenosis at high operative risk, with a potential future use also for low-risk subjects. In the last decade, a multitude of transcatheter mitral valve replacement (TMVR) devices have been developed for the treatment of severe mitral regurgitation, with encouraging results coming from first-in-man and feasibility studies...
January 5, 2018: Seminars in Thrombosis and Hemostasis
Tamer Owais, Mohammad El Garhy, Jürgen Fuchs, Kushtrim Disha, Sameh Elkaffas, Martin Breuer, Bernward Lauer, Thomas Kuntze
BACKGROUND: Left ventricular (LV) perforation is one of the rare and most serious complications of transcatheter aortic valve implantation (TAVI). The study aim was to determine the pathophysiological factors associated with this serious complication. METHODS: A retrospective study was conducted of pathophysiological factors shown in echocardiograms and computed tomography angiograms performed preoperatively in patients who developed LV perforation during transfemoral TAVI (study group) with regards to anatomic and functional variables...
July 2017: Journal of Heart Valve Disease
Jacopo Alfonsi, Giacomo Murana, Anna Corsini, Carlo Savini, Roberto Di Bartolomeo, Davide Pacini
Extensive mitral annulus calcifications are considered a contraindication for valve surgery. We describe the case of a 76-year-old female with severe mitral and aortic stenosis associated with extensive calcifications of the heart. The patient underwent an open mitroaortic valve replacement using transcatheter aortic valve implantation with an Edwards SAPIEN XT valve (Edwards Lifesciences Corp., Irvine, CA, USA) in the mitral position. The aortic valve was replaced using a stentless valve prosthesis (LivaNova SOLO; LivaNova PLC, London, UK)...
December 2017: Korean Journal of Thoracic and Cardiovascular Surgery
Anthony Putrino, Gregory Scalia, Sarvesh Natani, Swaroop Margale, Ivan Rapchuk, Simon Binny, Catherine Lau, Myo Lwin, Andrew Clarke, Christopher Raffel, Darren L Walters
In patients with a degenerative mitral bioprosthesis and prohibitive surgical risk there is emerging evidence for the feasibility of valve-in-valve procedures via a percutaneous transvenous transseptal approach. This paper describes the first time this procedure has been performed in Australia.
April 2018: Heart, Lung & Circulation
Jakob Ledwoch, Jennifer Franke, Edith Lubos, Peter Boekstegers, Miriam Puls, Taoufik Ouarrak, Stephan von Bardeleben, Christian Butter, Joachim Schofer, Ralf Zahn, Hüsseyin Ince, Jochen Senges, Horst Sievert
AIMS: The 6-min walk test (6 MWT) has been established as an important tool for functional assessment in heart failure patients. However, its prognostic impact on the outcome in subjects with mitral regurgitation undergoing transcatheter mitral valve repair is unknown. METHODS: This present work represents a sub-analysis of the German, prospective, multicenter, Transcatheter Mitral Valve Interventions (TRAMI) registry. Of the main study cohort (n = 828) 326 patients underwent 6 MWT prior to the procedure...
March 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Victor S Costache, Catalina Arsenescu, Andreea Costache, Horatiu Moldovan
A new controversy is raising in cardiovascular surgery, whether or not the new generation transcatheter valves used for valve implantation are superior to surgical techniques used for traditional valve replacement. If such a debate is far from being an issue for mitral valve treatment, where minimal invasive, (robotic or video-assisted) mitral valve repair has become the gold standard for mitral valve treatment while transcatheter mitral valve solutions are lagging behind(1-4), there are many voices stating that the future of aortic valve treatment will mainly be transcatheter(5)...
November 20, 2017: Minerva Cardioangiologica
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