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Pitfalls in TAMVI: experience with the repositionable Lotus® Valve System
Paul P Heinisch1, Fabien Praz2, Bernhard Winkler3
1Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland. ppheinisch@googlemail.com.
Journal of Cardiothoracic Surgery
|June 14, 2017
Summary
Transcatheter mitral valve implantation can cause left ventricular outflow tract obstruction. Careful preoperative assessment and use of repositionable devices are crucial for high-risk patients with combined valve disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Transcatheter aortic valve implantation (TAVI) and transcatheter mitral valve implantation (TMVI) offer alternatives to surgery for high-risk patients.
- Combined aortic and mitral valve disease presents complex therapeutic challenges.
- Simultaneous transapical implantation is a potential approach for combined valve disease.
Observation:
- A high-risk 59-year-old female with severe aortic stenosis and mitral stenosis underwent transapical TAVI.
- Preoperative imaging identified a narrow left ventricular outflow tract (LVOT), posing a risk for obstruction.
- A repositionable Lotus valve was chosen for mitral implantation due to potential LVOT obstruction.
Findings:
- Transcatheter aortic valve implantation was successful.
- An attempted transcatheter mitral valve implantation with a repositionable device resulted in acute LVOT obstruction.
- The mitral valve device required immediate removal.
Implications:
- Enhanced preoperative evaluation is essential for predicting LVOT obstruction during TMVI.
- Repositionable devices are preferred in borderline cases to manage potential LVOT obstruction.
- This case highlights the risks associated with TMVI in patients with narrow LVOT anatomy.
