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Balloon expandable transcatheter heart valves for native mitral valve disease with severe mitral annular

Mayra Guerrero1, Marina Urena, Amit Pursnani

  • 1Division of Cardiology, Evanston Hospital, North Shore University Health System, Evanston, IL, USA - mayraguerrero@icloud.com.

The Journal of Cardiovascular Surgery
|April 21, 2016
PubMed

Insights

Transcatheter mitral valve replacement (TMVR) offers a potential alternative for high-risk patients with severe mitral annular calcification (MAC). Early results show promise, but careful patient selection and imaging are crucial for success.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Mitral annular calcification (MAC) presents significant surgical risks for mitral valve replacement due to comorbidities and anatomical challenges.
  • Many patients with severe MAC are inoperable with conventional surgical approaches.
  • Transcatheter mitral valve replacement (TMVR) using balloon-expandable aortic valves has emerged as a compassionate use option.

Purpose of the Study:

  • To review the early clinical experience with transcatheter mitral valve replacement (TMVR) in patients with severe mitral annular calcification (MAC).
  • To summarize reported successes and failures of this emerging transcatheter therapy.
  • To assess the potential of TMVR as an alternative to surgery for high-risk MAC patients.

Main Methods:

  • Literature review of early TMVR cases in patients with severe MAC.
  • Analysis of reported procedural outcomes, including successes and complications.
  • Evaluation of the role of multimodality imaging in patient selection and risk assessment.

Main Results:

  • TMVR shows potential as an alternative for selected inoperable MAC patients.
  • The field is nascent, with progress expected to be slower than transcatheter aortic valve replacement due to mitral valve complexity.
  • Left ventricular outflow tract (LVOT) obstruction is a key complication requiring optimized patient selection and management strategies.

Conclusions:

  • TMVR may become an acceptable option for carefully selected severe MAC patients unsuitable for surgery.
  • Multimodality imaging is essential for accurate annular sizing and LVOT obstruction risk assessment.
  • Optimizing candidate selection, avoiding end-stage disease patients, and developing LVOT obstruction management are key to improving outcomes.

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