Thorac Cardiovasc Surg 2020; 68(S 01): S1-S72
DOI: 10.1055/s-0040-1705341
Oral Presentations
Sunday, March 1st, 2020
Heart Valve Disease
Georg Thieme Verlag KG Stuttgart · New York

Results of an Early Series of Transcatheter Mitral Valve Implantation with Dedicated Devices: Experience with Three Different Transapical and Transseptal Devices

L. Conradi
1   Hamburg, Germany
,
S. Ludwig
1   Hamburg, Germany
,
D. Kalbacher
1   Hamburg, Germany
,
A. Schäfer
1   Hamburg, Germany
,
Y. Schneeberger
1   Hamburg, Germany
,
N. Schofer
1   Hamburg, Germany
,
U. Schäfer
1   Hamburg, Germany
,
S. Blankenberg
1   Hamburg, Germany
,
H. Reichenspurner
1   Hamburg, Germany
,
E. Lubos
1   Hamburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
13 February 2020 (online)

Objectives: Dedicated devices for transcatheter mitral valve implantation (TMVI) have recently become available for use in high-risk patients suffering from severe mitral regurgitation (MR) who are ineligible for surgery. This is an early series with preliminary results of this novel technology.

Methods: From 2016 to 2019, a total of 141 patients were screened for TMVI. Of these, 30 (21.3%) high-risk patients (56.7% [17/30] male, age 76.6 ± 6.7 years, logEuroSCORE I 29.8 ± 12.4%, all NYHA class III/IV) were found eligible considering anatomical and clinical criteria. Transapical TMVI using Neovasc TIARA (n = 16), Abbott Tendyne (n = 11), HighLife (n = 1), or transseptal TMVI using Edwards CardiAQ (n = 2) devices were performed for severe symptomatic functional (n = 16), degenerative (n = 8), or mixed (n = 6) MR. Data from compassionate-use cases (n = 11) are presented according to Mitral Valve Academic Research Consortium (MVARC) definitions.

Results: Immediate technical success was achieved in all patients (78.5 [75.5–83.9] years, logEuroSCORE II 5.9 [4.3–12.1]%, 81.8% (9/11) female). Mean procedure and fluoroscopy times were 162 (131–185) and 29.5 (17.1–43.0) minutes, amount of contrast agent was 75.0 (40.5–112.3) mL. Intraprocedural left ventricular outflow tract obstruction necessitated device repositioning in one case. All but one patient were extubated in the hybrid OR immediately following the procedure. There was no procedural mortality. Device and procedural success rates at 30 days were 81.8% (9/11) and 90.9% (10/11), respectively. Access site complications and arrhythmia were observed in 9.1% (1/11) respectively, bleeding events occurred in 27.3% (3/11). All-cause in-hospital and 30-day mortality were 9.1% (1/11). No strokes were observed. Transthoracic echocardiography at 30 days revealed adequate valve function with residual MR trace in all patients and mean transvalvular gradient of 3.0 (2.0–4.0) mm Hg.

Conclusion: In this preliminary series of selected patients, excellent hemodynamic results after TMVI using three dedicated TMVI devices were demonstrated. Careful patient selection by computed tomography and echocardiographic parameters is key for clinical success and currently limits eligibility of a broader patient population.