Thorac Cardiovasc Surg 2014; 62 - OP39
DOI: 10.1055/s-0034-1367116

Transcatheter aortic valve implantation in patients with severe aortic stenosis and concomitant mitral stenosis

B. Kloth 1, M. Seiffert 2, L. Conradi 1, J. Schirmer 1, H. Reichenspurner 1, P. Diemert 2, H. Treede 1
  • 1Universitäres Herzzentrum Hamburg, Herz- und Gefäßchirurgie, Hamburg, Germany
  • 2Universitäres Herzzentrum Hamburg, Allgemeine und Interventionelle Kardiologie, Hamburg, Germany

Objectives: Transcatheter aortic valve implantation (TAVI) is an approved method in high risk patients with aortic stenosis unsuitable for surgical intervention. There are some reservations about transcatheter aortic valve replacement in patients with concomitant mitral stenosis because of the risk of intraoperative or postoperative cardiac decompensation and a benefit for these patients that is arguable. The risk for hemodynamic decompensation in TAVI with concomitant mitral stenosis is mainly caused by decreased periprocedural diastolic inflow in often severely hypertophic ventricles where a high preload is needed for sufficient hemodynamics. We have analyzed the outcome of 11 patients with mitral stenosis having undergone TAVI in our institution.

Methods: A total of 11 patients with concomitant mitral stenosis (mean gradient 8, range 5-12 mmHg) underwent transcatheter aortic valve-implantations between 08.2008 and 06.2013. All patients needed an aortic valve replacement because of a severe stenosis (mean gradient 41 mmHg (range 27-59 mmHg), EOA 05-08 cm2). The mean age of the patients was 83,3 years (range, 77-93), 8 were female and 3 were male and the mean logistic EuroSCORE, EuroSCORE II, and Society of Thoracic Surgeons score was 18,0; 7,2; and 7,7; respectively. Used devices were Symetis TF, Symetis TA, JenaValve, Sapien XT and Engager TA. The access route was transapical in 5 and transfemoral in 6 cases.

Results: No intraprocedural mortality occured. The technique success rate was 100%. Length of stay in intensive care unit was 2,6 days (1-10 days), in-hospital stay 11,6 days (5-21 days). The major complications within 30 days included major vascular complication in 1 patient, stroke in 1 patient and the need of pacemaker implantation in 2 patients. All-cause 30-day mortality was 0% and 10 of 11 patients had a reduction of NYHA-classification by at least one class.

Conclusions: Transcatheter valve implantation has become an established procedure in patients with aortic stenosis and high surgical risk. Also in patients with concomitant mitral stenosis who are not eligible for double valve surgery TAVI is a safe and feasible option.