Failure of a mitral bioprosthesis always poses a challenge regarding decision-making, especially when dealing with elderly patients with multiple risk factors. The scenario is worsened by the high risk associated with a new sternotomy and the significant impact of undergoing new surgery.
Transcatheter mitral valve-in-valve (TMViV) replacement is emerging as a valid strategy in the aforementioned cases of bioprosthesis failure. However, unfortunately, we currently lack comprehensive analyses and large-scale randomized studies.
In this study, researchers conducted an analysis of 20 consecutive symptomatic patients who underwent TMViV replacement due to bioprosthesis failure.
Subjects with mitral annulus, annular calcification in the surgical bioprosthesis, or a transapical percutaneous valve were excluded.
The average age was 64 years, and 12 patients were women. More than half of the patients had diabetes, preserved renal function, an STS Score of 8.1%, and a EuroSCORE II of 9.2%.
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Before the procedure, ejection fraction was 44%, with a mean gradient of 13 mmHg. Bioprosthesis failure presented as stenosis with regurgitation in 12 patients, stenosis alone in 5 cases, and regurgitation alone in 2.
The procedure was successful in all patients, with no mortality, infarcton, or stroke. Three patients experienced major bleeding, one required automatic implantable cardioverter defibrillator (AICD), another needed dialysis, and the average hospital stay was 7 days.
Mortality at 30 days and one year was 1 patient and 2 patients, respectively.
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After one year of follow-up, all patients were in functional classes I-II, with a gradient of 6 mmHg and an ejection fraction of 44%. All continued anticoagulation.
Conclusion
TMViM replacement with Meril Myval can be performed safely, with high technical success and low mortality at 30 days and one year.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Clinical Outcomes Following Transcatheter Mitral Valve-in-Valve Replacement Using a Meril Myval Transcatheter Heart Valve.
Reference: Mullasari Ajit Sankardas, et al. Heart, Lung and Circulation (2023) , article in press.
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