Transcatheter Aortic Valve Implantation after Previous Mechanical Mitral Valve Replacement: Expanding Indications?

Authors

  • Carsten J. Beller
  • Raffi Bekeredjian
  • Ulrike Krumsdorf
  • Rüdiger Leipold
  • Hugo A. Katus
  • Matthias Karck
  • Wolfgang Rottbauer
  • Klaus Kallenbach

DOI:

https://doi.org/10.1532/HSF98.20101148

Abstract

Background: Cardiac operation for severe aortic stenosis after previous mitral valve replacement is a surgical challenge in older patients with multiple morbidities. Transcatheter aortic valve implantation (TAVI) after previous mechanical mitral valve replacement has been considered a high-risk procedure, owing to possible interference with the mitral valve prosthesis.

Methods: Since August 2008, 5 female high-risk patients with severe aortic stenosis and previous mitral valve replacement (mean ± SD age, 80 ± 5.1 years; logistic EuroSCORE, 39.3% ± 20.5%) underwent TAVI with a pericardial xenograft valve that was fixed with a stainless steel, balloon-expandable stent (Edwards Lifesciences SAPIEN). We used a transapical approach in 4 patients and a transfemoral approach in 1 patient. Transesophageal echocardiography and multidetector computed tomography were used for preoperative planning and assessment of operation feasibility. The mean distance between the aortic annulus and the mitral valve prosthesis was 10 ± 1 mm (range, 9-11 mm).

Results: TAVI was performed successfully in all 5 patients. There was no direct or functional interference with the mechanical mitral valve prostheses. Echocardiography revealed good valve function with no more than mild paravalvular incompetence early in the postoperative period and during routine follow-up. There were no neurologic events. After an initially uneventful course with good aortic valve function at the most recent echocardiography evaluation, however, 2 of the patients died from fulminant pneumonia on postoperative days 4 and 48.

Conclusion: TAVI is technically feasible in high-risk patients after previous mechanical mitral valve replacement; however, careful patient selection is mandatory with respect to preoperative clinical status and anatomic dimensions regarding the distance between aortic annulus and mitral valve prosthesis.

References

Beyersdorf F. 2007. Transapical transcatheter aortic valve implantation. Eur J Cardiothorac Surg 31:7-8.nBruschi G, De Marco F, Oreglia J, et al. 2009. Percutaneous implantation of CoreValve aortic prostheses in patients with a mechanical mitral valve. Ann Thorac Surg 88:e50-2.nElahi M, Dhannapuneni R, Firmin R, Hickey M. 2005. Direct complications of repeat median sternotomy in adults. Asian Cardiovasc Thorac Ann 13:135-8.nKempfert J, Walther T, Borger MA, et al. 2008. Minimally invasive off-pump aortic valve implantation: the surgical safety net. Ann Thorac Surg 86:1665-8.nLichtenstein SV, Cheung A, Ye J, et al. 2006. Transapical transcatheter aortic valve implantation in humans: initial clinical experience. Circulation 114:591-6.nOdell JA, Mullany CJ, Schaff HV, Orszulak TA, Daly RC, Morris JJ. 1996. Aortic valve replacement after previous coronary artery bypass grafting. Ann Thorac Surg 62:1424-30.nRao V, Christakis GT, Weisel RD, et al. 1996. Changing pattern of valve surgery. Circulation 94:113-20.nScherner M, Strauch JT, Haldenwang PL, Baer F, Wahlers T. 2009. Successful transapical aortic valve replacement in a patient with a previous mechanical mitral valve replacement. Ann Thorac Surg 88:1662-3.nSvesson LG, Dewey T, Kapadia S, et al. 2008. United States feasibility study of transcatheter insertion of a stented aortic valve by the left ventricular apex. Ann Thorac Surg 86:46-54.nWalther T, Dewey T, Borger MA, et al. 2009. Transapical aortic valve implantation: step by step. Ann Thorac Surg 87:276-83.nWalther T, Falk V, Borger MA, et al. 2007. Minimally invasive transapical beating heart aortic valve implantation: proof of the concept. Eur J Cardiothorac Surg 31:9-15.nWalther T, Falk V, Borger MA, et al. 2009. Transapical aortic valve implantation in patients requiring redo surgery. Eur J Cardiothorac Surg 36:231-5.nWalther T, Simon P, Dewey T, et al. 2007. Transapical minimally invasive aortic valve implantation: multi-center experience. Circulation 116:I240-5.nYe J, Cheung A, Lichtenstein V, et al. 2007. Six-month outcome of transapical transcatheter aortic valve implantation in the initial seven patients. Eur J Cardiothorac Surg 31:16-21.n

Published

2011-06-15

How to Cite

Beller, C. J., Bekeredjian, R., Krumsdorf, U., Leipold, R., Katus, H. A., Karck, M., Rottbauer, W., & Kallenbach, K. (2011). Transcatheter Aortic Valve Implantation after Previous Mechanical Mitral Valve Replacement: Expanding Indications?. The Heart Surgery Forum, 14(3), E166-E170. https://doi.org/10.1532/HSF98.20101148

Issue

Section

Articles

Most read articles by the same author(s)

1 2 > >>