Anterior mitral leaflet perforation and infective endocarditis following transcatheter aortic valve replacement in a patient presenting with heart failure

Background: Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) and laceration of the anterior mitral leaflet to prevent outflow obstruction (LAMPOON) reduce the risk of coronary and left ventricular outflow obstruction obstruction during transcatheter aortic valve replacement and transcatheter mitral valve replacement. Despite successful laceration, BASILICA or LAMPOON may fail to prevent obstruction caused by inadequate leaflet splay in patients having challenging anatomy such as very small valve-to-coronary distance, diffusely calcified, rigid leaflets, or undergoing transcatheter aortic valve replacement inside existing transcatheter aortic valve replacement. We describe a novel technique of balloon-augmented (BA) leaflet laceration to enhance leaflet splay. Methods: We measured the incremental leaflet splay from BA-BASILICA in vitro. From November 2019 to March 2021, 16 patients underwent BA-BASILICA and 4 BA-LAMPOON at 3 centers. Results: BA-BASILICA increased benchtop leaflet tip splay 17%, maximum splay angle 30%, and splay area 23%, resulting in a more rounded apex and larger effective area. Sixteen patients at risk for inadequate BASILICA leaflet splay, including 4 transcatheter aortic valve replacement inside existing transcatheter aortic valve replacement, underwent BA-BASILICA. All had successful leaflet laceration. One had coronary obstruction requiring immediate orthotopic stenting. Two underwent elective orthotopic coronary stenting through the transcatheter valve cells for leaflet prolapse without coronary ischemia. There were no deaths during the procedure or at 30 days. Four patients at risk for inadequate anterior mitral leaflet splay underwent BA-LAMPOON. All had successful target leaflet laceration without left ventricular outflow obstruction obstruction or procedural death. One died within 30 days. Conclusions: BA leaflet laceration enhances leaflet splay in vitro and may allow transcatheter aortic valve replacement and transcatheter mitral valve replacement in patients otherwise ineligible for traditional BASILICA or LAMPOON due to challenging anatomy.

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Epidemiology of infective endocarditis in transcatheter aortic valve replacement: systemic review and meta-analysis

Journal of Cardiovascular Medicine ◽

10.2459/jcm.0000000000001001 ◽

2020 ◽

Vol 21 (10) ◽

pp. 790-801 ◽

Cited By ~ 1

Author(s):

Narut Prasitlumkum ◽

Wasawat Vutthikraivit ◽

Sittinun Thangjui ◽

Thiratest Leesutipornchai ◽

Jakrin Kewcharoen ◽

...

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Meta Analysis ◽

Systemic Review ◽

Transcatheter Aortic Valve

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Heart failure following transcatheter aortic valve replacement

Expert Review of Cardiovascular Therapy ◽

10.1080/14779072.2021.1949987 ◽

2021 ◽

pp. 1-15

Author(s):

Vassili Panagides ◽

Alberto Alperi ◽

Jules Mesnier ◽

Francois Philippon ◽

Mathieu Bernier ◽

...

Keyword(s):

Heart Failure ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Transcatheter Aortic Valve

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Abstract 13923: Incidence and Outcomes of Infective Endocarditis After 180 Days in Transcatheter Aortic Valve Replacement and Mitraclip

Circulation ◽

10.1161/circ.142.suppl_3.13923 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Manpreet Kaur ◽

Anas M Saad ◽

Keerat Ahuja ◽

Simrat Kaur ◽

Toshiaki Isogai ◽

...

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

International Classification Of Diseases ◽

Chi Square ◽

Transcatheter Aortic Valve ◽

Classification Of Diseases ◽

Chi Square Test

Background: Infective endocarditis (IE) after Transcatheter aortic valve replacement (TAVR) and Mitra Clip (MC) occurs less commonly but is associated with grave complications. We aim to report the incidence and outcomes of IE within 180 days of TAVR and MC. Methods: We used the Nationwide Readmissions Database (NRD) between 2014 and 2017 to select patients who underwent either TAVR or MC between January and June every year (to allow for at least 180 days of follow up in the NRD) using the appropriate International Classification of Diseases-9 th and 10 th revision (ICD) codes. We performed a chi-square test to compare baseline characteristics and rates of IE after TAVR and MC procedures. All statistical analyses were performed the using SPSS version 26. Results: We included 68,270 and 7,080 patients who underwent TAVR and MC respectively, of which 0.68% vs. 0.94% (P=.012), developed IE respectively within 180 days of procedure. During that index hospitalization, in-hospital mortality rates did not differ between the two groups (15.08% in TAVR vs. 17.91%, in MC P=.587). Other outcomes are presented in table 1. Conclusion: Our study suggests that the overall incidence of IE following TAVR and MC is relatively low but appropriate preventive measures should be taken after the procedures to reduce the morbidity and mortality. Further studies and analysis are required in modern MC and TAVR techniques to circumvent this critical complication.

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