TCT CONNECT-347 Overexpansion of Balloon-Expandable Aortic Transcatheter Heart Valves in the Mitral Valve Position
Al-Hijji M, Eleid M, Wang DD, Kodali S, Kaptzan T, El Sabbagh A, Oh J, O'Neill W, Rihal C, and Guerrero M. TCT CONNECT-347 Overexpansion of Balloon-Expandable Aortic Transcatheter Heart Valves in the Mitral Valve Position. Journal of the American College of Cardiology 2020; 76(17):B149-B150.
Journal of the American College of Cardiology
Background: Transcatheter mitral valve replacement using balloon-expandable aortic transcatheter heart valves (THVs) is emerging as alternative treatment for high surgical risk patients with symptomatic mitral valve disease due to bioprosthetic valve dysfunction, failed annuloplasty ring, and mitral annular calcification (MAC). THV deployment using higher contrast volume in the delivery balloon than nominal amount recommended by the manufacturer is not uncommon in order to flare the ventricular edge of the THV stent to help decrease embolization risk to the left atrium or treat paravalvular leak. This study aimed to determine the prevalence of THV overexpansion when used for mitral valve-in-valve, valve-in-ring, and valve-in-MAC, as well as its effects on rate of transvalvular mitral regurgitation (MR) and procedural outcomes.
Methods: A subanalysis was performed on 91 patients who were enrolled in the multicenter MITRAL (Mitral Implantation of Transcatheter Valves) trial from February 2015 to December 2017. The cohort was divided into 3 groups (nominal expansion,
Results: Mean age of patients was 74.5 ± 8.8 years and 52 were women (57.1%). Mean STS (Society of Thoracic Surgeons) score for 30-day mortality was 9.9 ± 6.6 for the entire population. Twenty-seven patients (29.7%) had THVs deployed at nominal expansion, whereas 64 THVs (70.3%) required overexpansion (53 required
Conclusion: Overexpansion during transcatheter mitral valve replacement using balloon-expandable aortic THV to flare the ventricular edge of the THV stent frame was not associated with significant rate of transvalvular MR. Further studies are needed.
ePub ahead of print