Edwards Sapien Xt in Native Stenotic Mitral Valve, Open Technique on Cardiopulmonary Bypass: An Option, but Safe?

2016 ◽  
Vol 11 (4) ◽  
pp. 288-290 ◽  
Author(s):  
Gry Dahle ◽  
Kjell Arne Rein ◽  
Arnt E. Fiane
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Edwards Sapien ◽  
Left Ventricular Outflow ◽  
Procedural Success ◽  
Transcatheter Valve ◽  
Valve Implantation

A 73-year-old woman underwent open mitral valve replacement with the transcatheter Edwards SAPIEN XT valve (Edwards Lifesciences, Corp, Irvine, CA USA) on cardiopulmonary bypass in a native, stenotic mitral valve. Because of left ventricular outflow tract obstruction, the patient died 25 days after implantation. There are previous reports of transcatheter valve implantation in native mitral valve with procedural success. However, in one case report, the patient died 10 days postoperatively.

scholarly journals Left Ventricular Outflow Tract Area After Percutaneous Transseptal Transcatheter Mitral Valve Implantation; A Three-dimensional Transesophageal Echocardiography Study

2021 ◽  
Author(s):  
atsushi hayashi ◽  
hiroki ikenaga ◽  
takafumi nagaura ◽  
Jun Yoshida ◽  
Florian Rader ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Transesophageal Echocardiography ◽  
Left Ventricular Outflow Tract ◽  
Strong Association ◽  
Multivariable Analysis ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Left Ventricular Outflow ◽  
Valve Implantation

Background: Left ventricular (LV) outflow tract (LVOT) obstruction increases mortality in patients undergoing transcatheter mitral valve implantation (TMVI) in degenerated bioprostheses, annuloplasty rings, and native mitral valves. We aimed to evaluate the left ventricular outflow tract area after TMVI using 3-diensional (3D) transesophageal echocardiography (TEE) and to investigate the pre-procedural cardiac geometry affects the LVOT area after TMVI. Methods: We retrospectively reviewed echocardiography data in 43 patients who had TMVI. A change in pressure gradient across LVOT from before to after TMVI (∆PG) and post-procedure 3D cross sectional area (CSA) at the level of the most distal portion of the mitral valve stent that was closest to the LV apex were assessed as evidence of LVOT narrowing. Results: TMVI with the use of balloon-expandable valve system was performed for 24 bioprostheses, 7 annuloplasty rings, and 12 native valves. Compared to patients without increase in LVOT gradient (∆PG <10 mmHg; n=33), patients with increase in LVOT gradient (∆PG ≥10 mmHg; n=10) had smaller LV end-systolic volume (LVESV), greater LV ejection fraction (LVEF) and smaller aorto-mitral (AM) angle. CSA at the valve stent distal edge showed strong association with ∆PG (r=-0.68, P<0.0001). Only small AM angle was associated with small CSA at the valve stent ventricular edge on multivariable analysis, independent of LVESV and LVEF. Conclusion: Pre-procedural AM angle as well as LVESV and LVEF were associated with LVOT narrowing in patients undergoing transcatheter mitral valve-in-valve, valve-in-ring, and valve-in-native valve implantation. These data may be useful for preprocedural planning.

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