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Transcatheter Mitral Valve-in-Valve Dislocation: A Rescue Strategy
Alessandro Leone1, Jacopo Alfonsi1, Emanuele Pilato1
1Division of Cardiac Surgery, Cardiothoracic and Vascular Department, S. Orsola Hospital, Bologna University, Bologna, Italy.
The Annals of Thoracic Surgery
|April 17, 2018
Summary
Transcatheter mitral valve-in-valve implantation can dislocate. A novel technique used a bare aortic stent to secure a dislodged mitral prosthesis in the aortic arch, ensuring vital blood flow.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Biomedical Engineering
Background:
- Degenerated mitral bioprostheses pose a challenge in high-risk patients.
- Transcatheter aortic valve replacement (TAVR) era has seen advancements in minimally invasive valve procedures.
- Transapical valve-in-valve mitral valve implantation is an alternative for specific patient groups.
Purpose of the Study:
- To report an unusual complication during transapical valve-in-valve mitral valve implantation.
- To describe a novel strategy for managing mitral prosthesis migration into the aortic arch.
- To demonstrate the successful stabilization of a dislocated mitral prosthesis.
Main Methods:
- A case report detailing a transapical valve-in-valve mitral valve implantation procedure.
- Management of a dislodged mitral prosthesis that migrated into the aortic arch.
- Deployment of a bare aortic stent to secure the migrated prosthesis.
Main Results:
- Successful repositioning and stabilization of the mitral prosthesis within the aortic arch.
- Prevention of potentially fatal complications associated with prosthesis migration.
- Ensured adequate perfusion to epiaortic vessels post-intervention.
Conclusions:
- Transapical valve-in-valve mitral valve implantation carries risks, including prosthesis migration.
- A bare aortic stent can be an effective salvage strategy for dislodged mitral prostheses in the aortic arch.
- This technique offers a solution for a rare but serious complication, ensuring patient safety and adequate cerebral perfusion.
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