The risk of surgical mitral valve replacement in patients with severe mitral annular calcification (MAC) is high. Several patients worldwide with severe MAC have been treated successfully with ...transcatheter mitral valve replacement (TMVR) using balloon-expandable aortic transcatheter valves. The TMVR in MAC Global Registry is a multicenter registry that collects data on outcomes of these procedures.
The goal of this study was to evaluate 1-year outcomes in this registry.
This study was a multicenter retrospective review of clinical outcomes.
A total of 116 extreme surgical risk patients with severe MAC underwent TMVR; 106 had a procedure date >1 year before data-lock and were included in the analysis. Their mean age was 73 ± 12 years, and 68% were female. The mean Society of Thoracic Surgeons score was 15.3 ± 11.6%, and 90% were in New York Heart Association functional class III or IV. Thirty-day and 1-year all-cause mortality was 25% and 53.7%, respectively. Most patients who survived 30 days were alive at 1 year (49 of 77 63.6%), and the majority (71.8%) were in New York Heart Association functional class I or II. Echocardiography data at 1 year were available in 34 patients. Mean left ventricular ejection fraction was 58.6 ± 11.2%, mean mitral valve area was 1.9 ± 0.5 cm2, mean mitral gradient was 5.8 ± 2.2 mm Hg, and 75% had zero or trace mitral regurgitation.
TMVR with balloon-expandable aortic valves in extreme surgical risk patients with severe MAC is feasible but associated with high 30-day and 1-year mortality. Most patients who survive the 30-day post-procedural period are alive at 1 year and have sustained improvement of symptoms and transcatheter valve performance. The role of TMVR in patients with MAC requires further evaluation in clinical trials.
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Transcatheter mitral valve replacement using balloon-expandable valves is an emerging technique for the treatment of patients with significant mitral regurgitation who have been judged to be ...inoperable owing to significant mitral valve annulus calcification. Although initial reports have been promising, there remains a lack of consensus as to how to plan for transcatheter mitral valve replacement deployment in terms of appropriateness, sizing, and positioning to mitigate the risks of valve displacement and paravalvular regurgitation. We describe two cases of transcatheter mitral valve replacement in patients with significant mitral valve annulus calcification. The first was complicated by valve displacement into the left atrium, which was successfully managed by surgical redeployment and fixation. The second case was thereafter performed successfully using iterative learning and the application of specific preprocedural planning techniques acquired from a root cause analysis of the first case. We describe our experience with both cases and the specific planning principles required to prevent transcatheter mitral valve replacement displacement in patients with mitral valve annulus calcification.
This study sought to evaluate the outcomes of the early experience of transcatheter mitral valve replacement (TMVR) with balloon-expandable valves in patients with severe mitral annular calcification ...(MAC) and reports the first large series from a multicenter global registry.
The risk of surgical mitral valve replacement in patients with severe MAC is high. There are isolated reports of successful TMVR with balloon-expandable valves in this patient population.
We performed a multicenter retrospective review of clinical outcomes of patients with severe MAC undergoing TMVR.
From September 2012 to July of 2015, 64 patients in 32 centers underwent TMVR with compassionate use of balloon-expandable valves. Mean age was 73 ± 13 years, 66% were female, and mean Society of Thoracic Surgeons score was 14.4 ± 9.5%. The mean mitral gradient was 11.45 ± 4.4 mm Hg and the mean mitral area was 1.18 ± 0.5 cm(2). SAPIEN valves (Edwards Lifesciences, Irvine, California) were used in 7.8%, SAPIEN XT in 59.4%, SAPIEN 3 in 28.1%, and Inovare (Braile Biomedica, Brazil) in 4.7%. Access was transatrial in 15.6%, transapical in 43.8%, and transseptal in 40.6%. Technical success according to Mitral Valve Academic Research Consortium criteria was achieved in 46 (72%) patients, primarily limited by the need for a second valve in 11 (17.2%). Six (9.3%) had left ventricular tract obstruction with hemodynamic compromise. Mean mitral gradient post-procedure was 4 ± 2.2 mm Hg, paravalvular regurgitation was mild or absent in all. Thirty-day all-cause mortality was 29.7% (cardiovascular = 12.5% and noncardiac = 17.2%); 84% of the survivors with follow-up data available were in New York Heart Association functional class I or II at 30 days (n = 25).
TMVR with balloon-expandable valves in patients with severe MAC is feasible but may be associated with significant adverse events. This strategy might be an alternative for selected high-risk patients with limited treatment options.
We describe a case of reversible thrombotic mitral valve stenosis following a valve‐in‐ring transcatheter mitral valve replacement. Life‐long oral anticoagulation in patients who underwent ...transcatheter mitral valve replacement might be beneficial.
INTRODUCTION
The transaortic (TAo) approach has been proposed as an alternative to the transapical approach and can be used in concomitant procedures. We use the TAo transcatheter aortic valve ...replacement (TAVR) with other simultaneous cardiac procedures in high‐risk patients who needed surgical management.
MATERIALS AND METHODS
Between September 2013 and September 2015, nine consecutive high‐risk patients with severe aortic valve stenosis (AR) and combined tricuspid valve disease or coronary artery disease were treated with TAo TAVR and simultaneous tricuspid valve repair or coronary artery bypass grafting.
RESULTS
Mean postoperative pressure gradient at discharge was 13.4 ± 3.2 mmHg and AR grade >2/4 was observed in one case (11.1%). New pacemaker implantation was required in one case (11.1%). Device success was achieved in 88.9% (n = 8), 30‐day mortality was in 11.1% (n = 1), and intermediate mortality was in 33.3% (n = 3).
CONCLUSION
TAo‐TAVR approach offers definitive treatment to high‐risk patients with coexisting complex cardiac lesions. Despite the relatively high 30‐day and intermediate mortality, it is an option for selected high‐risk patients.
Primary graft dysfunction (PGD) is a devastating complication and the most common cause of early death following a heart transplant. The goal of this study was to report our experience of using ...mechanical circulatory support to manage severe PGD.
Following 208 heart transplants performed between January 2007 and May 2017, 14 (6.7%) patients presented with severe PGD. We provided haemodynamic support using the following approaches: a venoarterial extracorporeal membrane oxygenation device, left ventricular assist device, right ventricular assist device and biventricular assist device. Primary complications included severe PGD, which resulted in hospital deaths and late survival. The mean follow-up was 3.7 ± 2.7 years.
Fourteen (6.7%) heart transplant recipients presented with severe PGD. Seven patients received a venoarterial extracorporeal membrane oxygenation device; 1 patient received a left ventricular assist device; 4 patients received a right ventricular assist device; and 2 patients received a biventricular assist device. Mean device support and explantation times were 4.7 ± 2 and 6.3 ± 2 days, respectively. Weaning with cardiac recovery was successful in 57.1% of the patients. The hospital mortality rate was 50%. Postoperative causes of morbidity included renal failure that necessitated dialysis in 28.5%, surgical re-exploration due to postoperative bleeding in 57.1%, pneumonia in 28.5%, sepsis in 14.2%, sternal wound infection in 14.2% and mediastinitis in 7.1% of the patients, respectively. There were no deaths following hospital discharge or later follow-up appointments.
Mechanical support devices such as venoarterial extracorporeal membrane oxygenation specifically offer a reliable therapeutic approach. Recognizing the relatively high number of deaths in-hospital, patients who have cardiac recovery and a successful hospital discharge can expect a favourable late outcome.
Based on a longtime voluntary registry founded by the Ministry of Healthcare of the Slovak Republic in 2012 and endorsed by the National Institute of Cardiovascular Diseases, well-defined data of all ...adult cardiac surgery procedures performed during the year 2021 are analyzed.
For this period, data on 947 procedures were submitted to the registry.
The unadjusted in-hospital survival rate for the 352 isolated coronary artery bypass grafting procedures including urgent and emergency procedures (relationship on-/off pump 3.8 : 1) was 96.3 %. For 331 isolated heart valve procedures (33 transcatheter interventions), it was 95.5 %. Concerning ventricular assist devices, 19 implantations were registered. In 2021 the number of isolated heart transplantations was 16, which is a decrease by 38.5 % as compared to the previous year.
These annually registered data are collected from voluntary public reporting and accumulate actual information on nearly all heart procedures carried out in the National Institute of Cardiovascular Diseases. These data capture advancements in heart medicine and represent the basis for quality management. In addition, the registry demonstrates that the provision of cardiac surgery in Slovakia is up to date, appropriate, and nationwide patient treatment is guaranteed all the time (Tab. 14, Fig. 2, Ref. 5). Text in PDF www.elis.sk Keywords: heart valve surgery, outcomes, coronary artery bypass grafting, aortic surgery, heart transplantation.
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