Transatrial implantation of a transcatheter heart valve for severe mitral annular calcification
| Autor: | Raymond Lee, Tsuyoshi Kaneko, Susheel Kodali, Vinayak Bapat, Hyde M. Russell, Martin B. Leon, Hiroo Takayama, Ashequl Islam, Fabien Praz, Omar K. Khalique, David W. Deaton, Michael A. Borger, Isaac George, Mayra Guerrero, Ramesh Veeragandham |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
Cardiac Catheterization Time Factors Echocardiography Three-Dimensional 030204 cardiovascular system & hematology Severity of Illness Index law.invention Postoperative Complications 0302 clinical medicine Aortic valve replacement Risk Factors law Mitral valve Mitral Valve Stenosis Hospital Mortality Aged 80 and over Heart Valve Prosthesis Implantation Calcinosis Mitral Valve Insufficiency Treatment Outcome medicine.anatomical_structure Heart Valve Prosthesis Mitral Valve Female medicine.symptom Cardiology and Cardiovascular Medicine Balloon Valvuloplasty Pulmonary and Respiratory Medicine medicine.medical_specialty Ventricular outflow tract obstruction Risk Assessment 03 medical and health sciences medicine Cardiopulmonary bypass Humans Heart valve Aged Mitral regurgitation business.industry Suture Techniques Hemodynamics Recovery of Function medicine.disease United States Surgery 030228 respiratory system Concomitant Tomography X-Ray Computed business Echocardiography Transesophageal Kidney disease |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 156:132-142 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2018.03.016 |
| Popis: | To assess the outcomes of transatrial implantation of a transcatheter heart valve (THV) for the treatment of mitral valve disease with severe mitral annular calcification (MAC).Implantation of a balloon-expandable THV was performed on cardiopulmonary bypass via left atrial exposure in patients considered at risk for left ventricular outflow tract obstruction. The anterior mitral valve leaflet was systematically resected and pledgeted sutures were placed to enhance stability and reduce paravalvular leak.Twenty-six consecutive symptomatic patients with severe MAC (mean age, 78 ± 7 years; 92% female; mean Society of Thoracic Surgeons score, 9.4 ± 4.8) were included at 6 different centers. Two patients (8%) received an Edwards Sapien XT (Edwards Lifesciences, Irvine, Calif), and 24 (92%) an Edwards Sapien 3 bioprosthesis (Edwards Lifesciences). Concomitant aortic valve replacement was performed in 11 patients. Technical success according to the criteria of the Mitral Valve Academic Research Consortium was achieved in all patients. The mean transmitral gradient decreased from 10 ± 5 to 4 ± 2 mm Hg (P .001) with trace or mild regurgitation in all patients. An elevated mean transaortic gradient (30 mm Hg) was observed in 1 patient (4%). Five patients died during hospital stay (19%) and 2 additional between discharge and 30 days (30-day mortality: 27%). Sustained functional improvement was observed in the remaining patients.Transatrial implantation of a THV for the treatment of MAC is associated with high technical success despite unfavorable anatomy. In this early experience of very high surgical risk patients, 30-day all-cause mortality was high. Patients at particular risk appear to be those with chronic kidney disease requiring multiple valve surgery. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|