Novel Transcatheter Mitral Valve Prosthesis for Patients With Severe Mitral Annular Calcification

  • Paul Sorajja
  • Mario Gössl
  • Vasilis Babaliaros
  • David Rizik
  • Lenard Conradi
  • Richard Bae
  • Robert F Burke
  • Ulrich Schäfer
  • John C Lisko
  • Robert D Riley
  • Robert Guyton
  • Nicolas Dumonteil
  • Pierre Berthoumieu
  • Didier Tchetche
  • Philipp Blanke
  • João L Cavalcante
  • Benjamin Sun

Abstract

BACKGROUND: Treatment of mitral regurgitation (MR) in the setting of severe mitral annular calcification (MAC) is challenging due to the high risk for fatal atrioventricular groove disruption and significant paravalvular leak.

OBJECTIVES: The objective of this study was to evaluate the potential for transcatheter mitral valve replacement in patients with severe MAC using an anatomically designed mitral prosthesis.

METHODS: Nine patients (77 ± 6 years of age; 5 men) were treated with the valve, using transapical delivery performed under general anesthesia and with guidance from transesophageal echocardiography and fluoroscopy.

RESULTS: Device implantation was successful with relief of MR in all 9 patients. There were no procedural deaths. In 1 patient, left ventricular outflow tract obstruction occurred due to malrotation of the prosthesis, and successful alcohol septal ablation was performed. During a median follow-up of 12 months (range 1 to 28 months), there was 1 cardiac death, 1 noncardiac death, no other mortality, and no prosthetic dysfunction, and MR remained absent in all treated patients. Rehospitalization for heart failure occurred in 2 patients who did not die subsequently. Clinical improvement with mild or no symptoms occurred in all patients alive at the end of follow-up.

CONCLUSIONS: Transcatheter mitral valve replacement in severe mitral annular calcification with a dedicated prosthesis is feasible and can result in MR relief with symptom improvement. Further evaluation of this approach for these high-risk patients is warranted.

Bibliographical metadata

Original languageEnglish
ISSN0735-1097
DOIs
Publication statusPublished - 17.09.2019
PubMed 31514943