Open atrial transcatheter mitral valve replacement in patients with mitral annular calcification

Hyde M. Russell, Mayra E. Guerrero, Michael H. Salinger, Melissa A. Manzuk, Amit K. Pursnani, Dee Wang, Hassan Nemeh, Rahul Sakhuja, Serguei Melnitchouk, Ashish Pershad, H. Kenith Fang, Sameh M. Said, James Kauten, Gilbert H.L. Tang, Gabriel Aldea, Ted E. Feldman, Vinnie N. Bapat, Isaac M. George

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: Mitral valve replacement in the setting of severe mitral annular calcification remains a surgical challenge. Transcatheter mitral valve replacement (TMVR) using an aortic balloon-expandable transcatheter heart valve is emerging as a potential treatment option for high surgical risk patients. Transseptal, transapical, or transatrial access is not always feasible, so an understanding of alternative implantation techniques is important. Objectives: The authors sought to present a step-by-step description of a contemporary transatrial TMVR technique using balloon-expandable aortic transcatheter heart valves. This procedure has evolved over time to address valve migration, left ventricular outflow tract obstruction, and paravalvular leak. The authors present a refined technique that has been associated with the most reproducible outcomes. Methods: A step-by-step description of the TMVR technique and outcomes of 8 patients treated using this technique are described. Baseline patient clinical and echocardiographic characteristics and 30-day post-TMVR outcomes are presented. Results: Eight patients underwent transatrial TMVR at a single institution. Five had previous cardiac surgery. Mean STS score was 8%. Technical success by MVARC (Mitral Valve Academic Research Consortium) criteria was 100%. There was zero in-hospital and 30-day mortality. Procedural success by MVARC criteria at 30 days was 100%. Paravalvular leak immediately post-implant was none or trace in 6 and mild in 1. Conclusions: The technique described is reproducible and was associated with favorable outcomes in this early experience. It represents a useful technique for the treatment of mitral valve disease in the setting of severe annular calcification. A structured and defined implantation technique is critical to investigators as this field evolves.

Original languageEnglish (US)
Pages (from-to)907-916
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume157
Issue number3
DOIs
StatePublished - Mar 2019
Externally publishedYes

Bibliographical note

Funding Information:
Dr Guerrero has received research funding from and been a proctor for Edwards Lifesciences. Dr Salinger has been a consultant for Edwards Lifesciences and Boston Scientific; and a proctor for Edwards Lifesciences. Dr Wang has been a consultant for Edwards Lifesciences, Boston Scientific, and Materialise; and is a co-inventor on a patent application assigned to Henry Ford Health System for software prediction of LVOT obstruction. Dr Sakhuja has been a consultant/proctor for Edwards Lifesciences and Medtronic. Dr Fang has been a consultant for Edwards Lifesciences. Dr Tang has been a proctor for Edwards Lifesciences. D. Feldman has received research funding from and been a consultant for Edwards Lifesciences, Abbott, and Boston Scientific. Dr Bapat has been a consultant for and received speaker fees from Edward Lifesciences and Medtronic. Dr George has been a consultant for Edwards Lifesciences, Medtronic, and Boston Scientific. All other authors have nothing to disclose with regard to commercial support.

Publisher Copyright:
© 2018 American College of Cardiology Foundation

Keywords

  • mitral annular calcification
  • surgery
  • valve replacement

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