Percutaneous Transseptal Bioprosthetic Implantation in Failed Prosthetic Surgical Mitral Valve - Brazilian Multicenter Experience.

Autor:	Nicz PFG; Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração - Hemodinâmica, São Paulo, SP - Brasil.; Hospital São Camilo Pompeia - Cardiologia Intervencionista, São Paulo, SP - Brasil., Melo PHMC; Hospital São Camilo Pompeia - Cardiologia Intervencionista, São Paulo, SP - Brasil.; Hospital Sírio-Libanês, São Paulo, SP - Brasil., Brito PHF; Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP - Brasil., Lima EN; Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP - Brasil., Silva RCE; Hospital São Camilo Pompeia - Cardiologia Intervencionista, São Paulo, SP - Brasil., Prudente ML; Hospital Encore, Goiânia, GO - Brasil., Fernandes FH; Hospital Encore, Goiânia, GO - Brasil., Deininger MO; Hospital Alberto Urquiza Wanderley, João Pessoa, PB - Brasil.; Hospital Memorial São Francisco, João Pessoa, PB - Brasil., Lopes MACQ; Hospital Alberto Urquiza Wanderley, João Pessoa, PB - Brasil., Petrucci FS; Hospital Memorial São Francisco, João Pessoa, PB - Brasil., Reis Filho FR; Hospital Madre Teresa, Belo Horizonte, MG - Brasil., Marino MA; Hospital Madre Teresa, Belo Horizonte, MG - Brasil., Bernardes RC; Hospital Madre Teresa, Belo Horizonte, MG - Brasil., Melo EP; Hospital Esperança Olinda - Rede D'Or São Luiz, Olinda, PE - Brasil., Oliveira MAP; Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP- Brasil., Mangione JA; Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP- Brasil., Mangione FM; Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP- Brasil., Falcão CHE; Complexo Hospitalar de Niterói, Niterói, RJ - Brasil., Martins ECC; Hospital de Força Aérea do Galeão, Rio de Janeiro, RJ - Brasil., Lunardi W; Hospital Sírio-Libanês, São Paulo, SP - Brasil., Bacal F; Universidade de São Paulo Instituto do Coração, São Paulo, SP - Brasil., Tarasoutchi F; Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração - Hemodinâmica, São Paulo, SP - Brasil., Brito FS Jr; Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas Instituto do Coração - Hemodinâmica, São Paulo, SP - Brasil.; Hospital Sírio-Libanês, São Paulo, SP - Brasil.
Jazyk:	English; Portuguese
Zdroj:	Arquivos brasileiros de cardiologia [Arq Bras Cardiol] 2020 Sep; Vol. 115 (3), pp. 515-524.
DOI:	10.36660/abc.20190252
Abstrakt:	Background: Percutaneous intervention in patients with bioprosthetic mitral valve dysfunction is an alternative to conventional surgical treatment. Objectives: To report the first Brazilian experience with transseptal transcatheter bioprosthetic mitral valve-in-valve implantation (transseptal-TMVIV). Methods: Patients with surgical bioprosthetic dysfunction submitted to transseptal-TMVIV in 12 Brazilian hospitals were included. The significance level adopted was p<0.05. Results: From June/2016 to February/2019, 17 patients underwent transseptal-TMVIV. Their median age was 77 years (IQR,70-82) and median Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) score was 8.7% (IQR,7.2-17.8). All patients had limiting symptoms of heart failure (FC≥III) and 5 (29.4%) had undergone more than one previous thoracotomy. Transseptal-TMVIV was successful in all patients. Echocardiographic assessment showed a significant reduction in mean mitral valve gradient (pre-intervention, 12±3.8 mmHg; post-intervention, 5.3±2.6 mmHg; p<0.001), in addition to an increase in mitral valve area (pre-intervention, 1.06±0.59 cm2; post-intervention, 2.18±0.36 cm2; p<0.001) sustained for 30 days. There was a significant and immediate reduction in the pulmonary artery systolic pressure, with an additional reduction in 30 days (pre-intervention, 68.9±16.4 mmHg; post-intervention, 57.7±16.5 mmHg; 30 days, 50.9±18.7 mmHg; p<0.001). During follow-up (median, 162 days; IQR, 102-411), significant clinical improvement (FC≤II) was observed in 87.5% of the patients. One patient (5.9%) had left ventricular outflow tract (LVOT) obstruction and died right after the procedure, and another died at 161 days of follow-up. Conclusion: The first Brazilian experience with transseptal-TMVIV shows the safety and effectivity of the new technique. The LVOT obstruction is a potentially fatal complication, reinforcing the importance of patients' selection and of procedural planning. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).
Databáze:	MEDLINE
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