Percutaneous complete repair of failed mitral valve prosthesis: Simultaneous closure of mitral paravalvular leaks and transcatheter mitral valve implantation - Single-centre experience

Chad Kliger, Rocio Angulo, Leandro Maranan, Robert Kumar, Vladimir Jelnin, Itzhak Kronzon, Gregory P. Fontana, Konstadinos Plestis, Nirav Patel, Gila Perk, Carlos E. Ruiz

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Aims: Structural deterioration and paravalvular leak (PVL) are complications associated with surgically implanted prosthetic valves, historically requiring reoperation. We present our experience of complete transcatheter repair of a degenerated mitral bioprosthesis. Methods and results: From March 2012 to October 2012, we reviewed consecutive, high-risk surgical patients (n=5) who underwent transcatheter repair of a failed mitral bioprosthesis with severe paravalvular regurgitation (PVR). Manufacturer valve sizes ranged from 27 to 33 mm, regurgitation (n=1), stenosis (n=1), or both (n=3). Percutaneous transapical and transseptal access were achieved with PVL closure performed transapically. An arteriovenous rail was created for transseptal delivery of a Melody valve. All patients had successful PVL closure with no residual PVR. Valve-in-valve (ViV) implantation was successful in four patients. Overall, mean transvalvular mitral gradient was 11.2 mmHg pre-procedure which improved to 5 mmHg post-procedure. Improvement of NYHA Class ≥2 was achieved in all patients (19±3 months). One patient had controlled Melody valve embolisation which required emergent surgical replacement. Inner valve diameter was 26 mm, too large for Melody valve implantation. Conclusions: Complete transcatheter repair of a degenerated mitral bioprosthesis with PVR can be performed in the high-risk patient. Accurate measurement is necessary prior to intervention, with concern for embolisation among the larger valve sizes (>31 mm).

Original languageEnglish (US)
Pages (from-to)1336-1345
Number of pages10
JournalEuroIntervention
Volume10
Issue number11
DOIs
StatePublished - Mar 1 2015

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Kliger, C., Angulo, R., Maranan, L., Kumar, R., Jelnin, V., Kronzon, I., Fontana, G. P., Plestis, K., Patel, N., Perk, G., & Ruiz, C. E. (2015). Percutaneous complete repair of failed mitral valve prosthesis: Simultaneous closure of mitral paravalvular leaks and transcatheter mitral valve implantation - Single-centre experience. EuroIntervention, 10(11), 1336-1345. https://doi.org/10.4244/EIJY14M05_01