Transcatheter mitral valve-in-ring implantation after failure of surgical mitral ring annuloplasty
Jain T, Wang DD, Eng M, Isley M, Paone G, Greenbaum A, O'Neill W. Transcatheter mitral valve-in-ring implantation after failure of surgical mitral ring annuloplasty. J Am Coll Cardiol. Mar 2017;69(11):1262-1262.
J Am Coll Cardiol
Background: Transcatheter mitral valve-in-ring implantation (TVIR) after failed surgical ring annuloplasty may offer a lower risk alternative treatment in patients deemed high risk for surgical reoperation. We sought to evaluate the relationship between post-TVIR echocardiographic data, brain natriuretic peptide (BNP) levels, and New York Heart Association (NYHA) functional classification as a measure of clinical impact of TVIR. Methods: We evaluated a series of 5 patients who underwent transvenous transseptal TVIR implantation using Edwards SAPIEN XT (3/5) or S3 (2/5) prosthesis from December 2013 to August 2015. Baseline, immediate and 30-day post-procedure echocardiographic and clinical outcomes were analyzed. Results: Mean age at time of TVIR was 73±3 years. Procedural success was 100% with reduction of mean MV gradients (mmHg) from 8.5 ± 3.7 to 4.1 ± 1.4 post-procedure (p<0.05) and 6.3 ± 2.3 at 30-days (p=0.09). BNP (pg/ml) improved from 510 ± 249 to 377 ± 229 postprocedure (p<0.05). There were no cases of valve malposition, embolization or significant perivalvular leak at 30-days. At 30-days, NYHA class improved from III/IV to I/II (p<0.05). Conclusions: TVIR implantation in selected high risk patients with failed mitral ring annuloplasty resulted in short-term clinical and hemodynamic improvement as demonstrated by improved MV gradients, BNP and NYHA class. Larger studies with longer follow-up are needed to assess the long-term clinical impact of change in mean MV gradient over time. (Table presented).