Outcomes after transcatheter mitral valve implantation in valve-in-valve, valve-in-ring, and valve-in-mitral annular calcification

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2024-07-30 DOI:10.1002/ccd.31166

Hector A. Alvarez-Covarrubias MD, MSc, PhD, Michael Joner MD, Marius Lutz MD, Erion Xhepa MD, PhD, N. Patrick Mayr MD, Mark Lachmann MD, Salvatore Cassese MD, PhD, Tobias Rheude MD, Costanza Pellegrini MD, Sebastian Kufner MD, Heribert Schunkert MD, Adnan Kastrati MD, Magdalena Erlebach MD, Rüdiger Lange MD, Hendrik Ruge MD

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Abstract

Aims

We aimed to evaluate transcatheter mitral valve implantation (TMVI) using predominantly balloon-expandable transcatheter heart valves (THV) in patients with a landing zone for a percutaneously delivered prosthesis.

Background

Patients with a degenerated mitral valve bioprosthesis, annuloplasty ring, and mitral annulus calcification (MAC) considered at high surgical risk currently represent a treatment challenge. TMVI is an alternative treatment option.

Methods

Retrospective analysis of patients with symptomatic degenerated mitral valve bioprosthesis, or annuloplasty ring, and MAC treated with TMVI between November 2011 and April 2021. Endpoints were defined according to Mitral Valve Academic Research Consortium (MVARC) criteria and included device and procedure success at 30 days as well as mortality at 30 days and 1 year after the procedure.

Results

A total of 77 patients underwent TMVI (valve in valve [ViV = 56], valve in ring [ViR = 11], and valve in MAC [ViMAC = 10]). There was a trend toward higher technical success (all = 93.5%, ViV = 96.4%, ViR = 90.9%, ViMAC = 80%, p = 0.06) and lower 30-day (all = 11.7%, ViV = 10.7%, ViR = 9.1%, ViMAC = 20%, p = 0.49) and 1-year mortality (all = 26%, ViV = 23.2%, ViR = 27.3%, ViMAC= 40%, p = 0.36) after ViV and ViR compared to ViMAC.

Conclusion

TMVI represents a reasonable treatment option in selected patients with MAC or who are poor candidates for redo mitral valve surgery. Technical success and survival up to 1 year were not significantly dependent on the subgroup in which TMVI was performed.

Abstract Image

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瓣中瓣、环中瓣和瓣环钙化经导管二尖瓣植入术后的疗效。

目的：我们旨在评估主要使用球囊扩张经导管心脏瓣膜（THV）在经皮置入假体着床区患者中进行经导管二尖瓣植入术（TMVI）的情况：背景：二尖瓣生物假体退变、瓣环成形术和二尖瓣环钙化（MAC）的高手术风险患者目前面临着治疗难题。TMVI 是一种替代治疗方案：回顾性分析 2011 年 11 月至 2021 年 4 月期间接受 TMVI 治疗的有症状的退化二尖瓣生物瓣膜、瓣环和二尖瓣瓣环钙化患者。终点根据二尖瓣学术研究联盟（MVARC）的标准定义，包括30天的设备和手术成功率以及术后30天和1年的死亡率：共有 77 名患者接受了二尖瓣置换术（瓣中瓣 [ViV = 56]、环中瓣 [ViR = 11] 和 MAC 中瓣 [ViMAC = 10]）。与 ViMAC 相比，ViV 和 ViR 有更高的技术成功率（全部 = 93.5%，ViV = 96.4%，ViR = 90.9%，ViMAC = 80%，p = 0.06）和更低的 30 天死亡率（全部 = 11.7%，ViV = 10.7%，ViR = 9.1%，ViMAC = 20%，p = 0.49）和 1 年死亡率（全部 = 26%，ViV = 23.2%，ViR = 27.3%，ViMAC = 40%，p = 0.36）的趋势：结论：TMVI是针对部分二尖瓣狭窄患者或不适合重做二尖瓣手术的患者的合理治疗方案。技术成功率和 1 年生存率与实施 TMVI 的亚组无明显关系。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.