Minimally Invasive Direct Access Balloon-Expandable Transcatheter Mitral Valve Replacement for Extensive Mitral Annular Calcification after Transcatheter Aortic Valve Replacement

Abstract Aims Mitral annular calcification (MAC) has been associated with adverse outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) but has been investigated in isolation of co-existent mitral regurgitation or mitral stenosis, which may represent important confounders. This study sought to investigate the effect of MAC with and without concomitant mitral valve disease (MVD) on clinical outcomes in patients treated with TAVR. Methods and results Computed tomography (CT) and echocardiographic data in consecutive TAVR patients enrolled into a prospective registry were categorized according to presence or absence of severe MAC and significant MVD, respectively. A total of 967 patients with adequate CT and echocardiography data were included between 2007 and 2017. Severe MAC was found in 172 patients (17.8%) and associated with MVD in 87 patients (50.6%). Compared to TAVR patients without severe MAC or MVD, all-cause mortality at 1 year was significantly increased among patients with severe MAC in combination with MVD [adjusted hazard ratio (HRadj): 1.97, 95% confidence interval (CI): 1.12–3.44, P = 0.018] and patients with isolated MVD (HRadj: 2.33, 95% CI: 1.56–3.47, P < 0.001), but not in patients with isolated severe MAC in the absence of MVD (HRadj: 0.52, 95% CI: 0.21–1.33, P = 0.173). Conclusion We found no effect of isolated MAC on clinical outcomes following TAVR in patients with preserved mitral valve function. Patients with MVD had an increased risk of death at 1 year irrespective of MAC.

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Minimally Invasive Direct Access Balloon-Expandable Transcatheter Mitral Valve Replacement for Extensive Mitral Annular Calcification after Transcatheter Aortic Valve Replacement

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000496 ◽

2018 ◽

Vol 13 (3) ◽

pp. 222-225

Author(s):

Joseph Lamelas ◽

Guilherme V. Silva ◽

Subhasis Chatterjee

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Minimally Invasive ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Mitral Annular Calcification ◽

Transcatheter Aortic Valve ◽

Transcatheter Mitral Valve Replacement ◽

Annular Calcification

Mitral annular calcification can pose a formidable surgical challenge in the setting of mitral valve replacement for mitral stenosis. Although there are reports of transapical valve-in-valve transcatheter mitral valve replacement in the setting of degenerated bioprosthetic mitral valve replacement, there is less experience with transcatheter mitral valve replacement for mitral annular calcification. This report describes a patient who previously received a transcatheter aortic valve replacement and then subsequently underwent a minimally invasive right thoracotomy for transcatheter mitral valve replacement with a successful result. We discuss technical pearls and operative considerations based on an extensive experience with minimally invasive valve surgery from a right mini-thoracotomy.

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