Self-Expanding Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis Undergoing Prosthetic Mitral Valve Replacement: A Single-Center Experience.

Abstract

Background: Following the encouraging results of several registries and trials, transcatheter aortic valve implantation has become standard therapy for aortic stenosis patients with intermediate or high operative risk for surgical treatment. Good procedural success and good clinical outcomes have been shown, but very limited data exist on transcatheter aortic valve implantation in the setting of a preexisting mitral valve (MV) prosthesis regarding the technique, potential complications, and outcomes. Single-center experience is presented with this special patient cohort.

Methods: Here, 31 cases of transfemoral transcatheter aortic valve implantation with a self-expanding bioprosthesis (CoreValve and Evolut R; Medtronic, Minneapolis, MN, USA) in patients who had previously undergone MV surgery have been reported. Preprocedural, intraprocedural, and post-procedural outcomes and data were analyzed.

Results: Between February 2013 and December 2023, 31 patients with prior MV prostheses were included. The average age was 68.7 years, and 77.4% were female. Mechanical MV prostheses were present in 90.3% of patients. The mean Society of Thoracic Surgeon score was 9.03. Transcatheter aortic valve implantation was performed 14.75 years after MV replacement. Post-procedural complications included access site issues in 25.8% of patients, with 22.5% requiring pacemaker implantation. No procedural mortality occurred. Six out of 31 patients (n = 6/31 patients) died during follow-up, primarily due to respiratory complications, and the mean survival time was 74.9 ± 8.4 months (95% CI: 58.4-91.4).

Conclusion: The experiences showed that transfemoral implantation of a self-expanding aortic valve with MV prostheses patients, via the transfemoral route, is safe and feasible, with maintained long-term results.