Transseptal Implantation of a Transcatheter Heart Valve in a Mitral Annuloplasty Ring to Treat Mitral Repair Failure

Background Transcatheter valve-in-ring strategies have been developed to treat recurrent mitral regurgitation (MR) after failing surgical annuloplasty. However, suboptimal THV expansion with consecutive paravalvular leakage (PVL) is a procedure-immanent issue. Methods A rigid, saddle-shaped ring was cut at four locations. The segments were reconnected with pull-springs, rearranged to the original shape, and covered with a sewing cuff. The length of the annuloplasty ring construct, including extended pull-springs, was defined by the perimeter of an appropriate THV. We deployed a Sapien XT within the new ring, expanded it to its maximum extent, and investigated the geometrical changes. Results Fluoroscopy confirmed oval, saddle-shaped ring before dilation. After THV implantation, the ring segments spread apart and pull-springs were stretched. The extended ring changed its configuration from “oval” to “round” and anchored the THV leaving no paravalvular or central gaps as potential source for PVL. Conclusion We developed an expandable annuloplasty ring that is perfectly concerted to THV implantation. This proof-of-concept study revealed no PVL and good oversizing ability that might impact future annuloplasty ring design. Further studies have to evaluate durability and device safety.

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Faculty Opinions recommendation of A randomized evaluation of the SAPIEN XT transcatheter heart valve system in patients with aortic stenosis who are not candidates for surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726049280.793523900 ◽

2016 ◽

Author(s):

Nawwar Al-Attar

Keyword(s):

Aortic Stenosis ◽

Heart Valve ◽

Valve System ◽

Randomized Evaluation ◽

Transcatheter Heart Valve

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Faculty Opinions recommendation of The JUPITER registry: 1-year results of transapical aortic valve implantation using a second-generation transcatheter heart valve in patients with aortic stenosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726390141.793519343 ◽

2016 ◽

Author(s):

John Augoustides

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Heart Valve ◽

Second Generation ◽

Transcatheter Heart Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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Transcatheter heart valve implant in bicuspid aortic valves with large annuli

IHJ Cardiovascular Case Reports (CVCR) ◽

10.1016/j.ihjccr.2020.12.011 ◽

2021 ◽

Author(s):

Pravin K. Goel ◽

Roopali Khanna ◽

Ankit Kumar Sahu ◽

Neeraj Jain

Keyword(s):

Heart Valve ◽

Aortic Valves ◽

Transcatheter Heart Valve ◽

Bicuspid Aortic Valves

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Case report: Buddy wire technique to facilitate atrial septal crossing during transcatheter transseptal mitral valve implantation

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa373 ◽

2020 ◽

Author(s):

Ashvarya Mangla ◽

Ameer Musa ◽

Clifford J Kavinsky ◽

Hussam S Suradi

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Heart Valve ◽

Interatrial Septum ◽

Chronic Obstructive ◽

Mitral Valve Stenosis ◽

Heart Team ◽

Transcatheter Heart Valve ◽

Valve Implantation ◽

Buddy Wire

Abstract Background Transcatheter mitral valve-in-valve implantation (MVIV) has emerged as a viable treatment option in patients at high risk for surgery. Occasionally, despite appropriate puncture location and adequate dilation, difficulty is encountered in advancing the transcatheter heart valve across interatrial septum. Case summary We describe a case of a 79-year-old woman with severe chronic obstructive pulmonary disease (COPD), prior surgical bioprosthetic aortic and mitral valve replacement implanted in 2007, atrial fibrillation, and Group II pulmonary hypertension who presented with progressively worsening heart failure symptoms secondary to severe bioprosthetic mitral valve stenosis and moderate-severe mitral regurgitation. Her symptoms had worsened over several months, with multiple admissions at other institutions with treatment for both COPD exacerbation and heart failure. Transoesophageal echocardiogram demonstrated preserved ejection fraction, normal functioning aortic valve, and dysfunctional mitral prosthesis with severe stenosis (mean gradient 13 mmHg) and moderate-severe regurgitation. After a multi-disciplinary heart team discussion, the patient underwent a transcatheter MVIV implantation. During the case, inability in advancing the transcatheter heart valve (THV) across interatrial septum despite adequate septal balloon pre-dilation was successfully managed with the support of a stiff ‘buddy wire’ anchored in the left upper pulmonary vein using the same septal puncture. The patient tolerated the procedure well and was discharged home. Discussion Operators should be aware of potential strategies to advance the THV when difficulty is encountered in crossing the atrial septum despite adequate septal preparation. One such strategy is the use of stiff ‘buddy wire’ for support which avoids the need for more aggressive septal dilatation.

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