scholarly journals Acute and Short-Term Outcomes of Percutaneous Transcatheter Mitral Valve Replacement in Children

2021 ◽  
Author(s):  
Nicola Maschietto ◽  
Ashwin Prakash ◽  
Pedro del Nido ◽  
Diego Porras
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Pediatric Patients ◽  
Surgical Techniques ◽  
Postoperative Mortality ◽  
Surgical Risk ◽  
Transcatheter Mitral Valve Replacement ◽  
High Surgical Risk ◽  
Valve In Valve

Background: Despite the improvement of surgical techniques for mitral valve (MV) repair in children, mitral valve replacement (MVR) is sometimes still necessary. MVR and redo-MVR continue to be burdened by early postoperative mortality and long-term morbidity with only about 75% of these patients being alive or transplant-free 10 years after the initial MVR. Although transcatheter MVR (TMVR) is a well-established intervention in high surgical risk adults, only a few pediatric valve-in-valve case reports have been published. The purpose of this study was to describe our initial experience with the off-label use of the Sapien S3 valve for TMVR in a highly selected pediatric patient population. Methods: We conducted a retrospective analysis of pediatric patients who underwent TMVR at Boston Children’s Hospital between October 2018 and July 2020. Results: Eight consecutive high surgical risk pediatric patients (median age, 9 years; range, 8–15) underwent TMVR (7 as valve-in-valve, 1 in a native MV). Each patient previously underwent multiple MV surgeries or MVR (median 4, range 2–5) and was highly symptomatic (Ross functional class 3 or 4). The indication for TMVR was mitral stenosis in 4 patients, regurgitation in 1, and mixed disease in 3. TMVR was successful in each patient, effectively reduced the left atrium and pulmonary hypertension ( P =0.012 and 0.043 respectively), and was carried out without significant complications. Conclusions: TMVR is an attractive alternative to MVR in high surgical risk patients. In this small series, TMVR was acutely effective and safe, with very encouraging early results.

Abstract 17193: Acute and Short-Term Outcomes of Percutaneous Transcatheter Mitral Valve Replacement in Children

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nicola Maschietto ◽  
Ashwin Prakash ◽  
Pedro J Del Nido ◽  
Diego Porras
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Pediatric Patients ◽  
Surgical Techniques ◽  
Postoperative Mortality ◽  
Surgical Risk ◽  
Small Series ◽  
Transcatheter Mitral Valve Replacement ◽  
High Surgical Risk

Introduction: Despite the improvement of surgical techniques for mitral valve (MV) repair in children, mitral valve replacement (MVR) is sometimes still necessary. MVR and redo-MVR continue to be burdened by early postoperative mortality and long-term morbidity with only about 75% of these patients being alive or transplant-free 10 years after the initial MVR. Although trans-femoral mitral valve replacement (TMVR) is a well-established intervention in high surgical risk adults, only a few pediatric Valve-in-Valve (ViV) case reports have been published. Hypothesis: We hypothesized that trans-venous transcatheter mitral valve replacement is feasible, safe, and effective in pediatric patients. Methods: Retrospective analysis of pediatric patients who underwent TMVR at Boston Children's Hospital between October 2018 and May 2020 Results: 7 consecutive high surgical risk pediatric patients (median age 9 years, range 8-15) underwent TMVR (6 as ViV, 1 in a native MV). Each patient previously underwent multiple MV surgeries or MVR (median 4, range 2-5) and was highly symptomatic (Ross functional class 3 or 4). The indication for TMVR was mitral stenosis in 5 patients, regurgitation in 1, and mixed disease in 1. TMVR was successful in each patient, effectively reduced the left atrium hypertension (p=0.018), and was carried out without significant complications. Conclusion: Trans-venous trans-catheter mitral valve replacement is an attractive alternative to MVR in high surgical risk patients. In this small series, TMVR was acutely effective and safe, with very encouraging early results.

scholarly journals Current Status of Catheter-based Mitral Valve Replacement

2021 ◽  
Vol 23 (8) ◽  
Author(s):  
Elias Rawish ◽  
Tobias Schmidt ◽  
Ingo Eitel ◽  
Christian Frerker
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Current Status ◽  
Bleeding Complications ◽  
Thrombotic Risk ◽  
Surgical Risk ◽  
Transcatheter Mitral Valve Replacement ◽  
High Surgical Risk

Abstract Purpose of review Transcatheter mitral valve replacement (TMVR) has been developed to address the need for an alternative therapeutic option to surgery in patients suffering from severe mitral regurgitation who are at high surgical risk. The present review illustrated the state-of-the-art of catheter-based mitral valve replacement evaluating technical characteristics and early clinical experience of different devices to outline prospects and challenges of TMVR. Recent findings Several devices are currently under clinical assessment. Early experience has demonstrated high procedural success of TMVR. However, TMVR faces several possible hurdles such as left ventricular outflow tract obstruction (LVOTO) after prosthesis deployment, access site complications, and thrombotic risk requiring anticoagulatory therapy. Summary Future studies should assess long-term prosthesis stability, optimal anticoagulation regime, and occurrence of paravalvular leakage. The development of smaller TMVR prostheses suitable for transseptal implantation could overcome bleeding complications. In perspective, TMVR may emerge to a clinically relevant therapeutic approach for patients with severe MR at high surgical risk.

scholarly journals Transcatheter Mitral Valve Replacement: Evolution and Future Development

2021 ◽  
Author(s):  
Lina Ya’qoub ◽  
Marvin Eng
Keyword(s):  
Computed Tomography ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Future Research ◽  
Early Outcome ◽  
Transcatheter Mitral Valve Replacement ◽  
Valve In Valve ◽  
Procedural Planning ◽  
Annular Calcification

We will review transcatheter mitral valve replacement (TMVR) and discuss this evolving cutting edge procedure in terms of types (valve in valve, valve in ring and valve in mitral annular calcification MAC), clinical indications, pre-procedural planning and value of pre-procedural imaging including computed tomography role, technical challenges encountered in these procedures, potential complications for each type of TMVR, and potential strategies to mitigate and avoid such complications, We will review the currently available devices dedicated for mitral valve replacement, with a summary of their preliminary data and early outcome results. We will also discuss knowledge gaps and ideas for future research.

scholarly journals Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample

2021 ◽  
Author(s):  
Muhammad Zia Khan ◽  
Salman Zahid ◽  
Muhammad U. Khan ◽  
Asim Kichloo ◽  
Shakeel Jamal ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Perioperative Complications ◽  
Cost Of Care ◽  
Heart Team ◽  
National Inpatient Sample ◽  
Mortality And Morbidity ◽  
Transcatheter Mitral Valve Replacement ◽  
Valve In Valve

Background Redo mitral valve surgery is required in up to one‐third of patients and is associated with significant mortality and morbidity. Valve‐in‐valve transcatheter mitral valve replacement (ViV TMVR) is less invasive and could be considered in those at prohibitive surgical risk. Studies on comparative outcomes of ViV TMVR and redo surgical mitral valve replacement (SMVR) remain limited. Our study aimed to investigate the real‐world outcomes of the above procedures using the National Inpatient Sample database. Methods and Results We analyzed National Inpatient Sample data using the International Classification of Diseases, Tenth Revision, Clinical Modification ( ICD‐10‐CM ) from September 2015 to December 2018. A total of 495 and 2250 patients underwent redo ViV TMVR and SMVR, respectively. The patients who underwent ViV TMVR were older (77 versus 68 years, P <0.01). Adjusted mortality was higher in the redo SMVR group compared with the ViV TMVR group (7.6% versus <2.8%, P <0.01). Perioperative complications were higher among patients undergoing redo SMVR including blood transfusions (38% versus 7.6%, P <0.01) and acute kidney injury (36.7% versus 13.9%, P <0.01). Cost of care was higher (USD$57 172 versus USD$52 579, P <0.01), length of stay was longer (10 versus 3 days, P <0.01), and discharge to home was lower (20.3% versus 64.6%, P <0.01) in the SMVR group compared with the ViV TMVR group. Conclusions ViV TMVR is associated with lower mortality, periprocedural morbidity, and resource use compared with patients undergoing redo SMVR. ViV TMVR may be a viable option for some patients with mitral prosthesis dysfunction. Studies evaluating long‐term outcomes and durability of ViV TMVR are needed. A patient‐centered approach by the heart team, local institutional expertise, and careful preprocedure planning can help decision‐making about the choice of intervention for the individual patient.

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