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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
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Contemporary Transcatheter Mitral Valve Replacement for Mitral Annular Calcification or Ring
Jasleen Tiwana1, Gabriel Aldea2, Dmitry B Levin1
1Division of Cardiology, University of Washington, Seattle, Washington.
JACC. Cardiovascular Interventions
|October 4, 2020
Summary
Commercial transcatheter mitral valve replacement (TMVR) for severe mitral annular calcification (ViMAC) and failing ring repairs (ViRing) is feasible. These procedures often require advanced techniques, with variable outcomes and complications.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Transcatheter mitral valve replacement (TMVR) is an emerging option for severe mitral annular calcification (MAC) and failed mitral valve ring repairs.
- Adjunctive techniques like anterior mitral leaflet laceration and alcohol septal ablation are used but not well-studied.
Purpose of the Study:
- To evaluate the outcomes of commercial TMVR procedures for MAC (ViMAC) and valve-in-ring (ViRing).
- To assess the safety and efficacy of contemporary techniques used during TMVR.
Main Methods:
- A single-center study included 40 patients undergoing ViMAC or ViRing TMVR between September 2015 and April 2020.
- In-hospital and 30-day outcomes were assessed, including adverse events and technical success.
Main Results:
- Six patients (15%) died within 30 days; 21% in the ViMAC group and 0% in the ViRing group.
- Left ventricular outflow tract obstruction occurred in 13% of patients. Technical success was 63% overall.
- Significant reduction in mitral valve gradient was observed at 30 days.
Conclusions:
- Transcatheter ViMAC and ViRing are viable options for complex mitral valve disease.
- Contemporary adjunctive techniques are frequently necessary for successful TMVR outcomes.
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