Novel Transcatheter Mitral Valve Prosthesis for Patients With Severe Mitral Annular Calcification

• Published in: Journal of the American College of Cardiology 2019-09, Vol.74 (11), p.1431-1440
• Main Authors: Sorajja, Paul, Gössl, Mario, Babaliaros, Vasilis, Rizik, David, Conradi, Lenard, Bae, Richard, Burke, Robert F., Schäfer, Ulrich, Lisko, John C., Riley, Robert D., Guyton, Robert, Dumonteil, Nicolas, Berthoumieu, Pierre, Tchetche, Didier, Blanke, Philipp, Cavalcante, João L., Sun, Benjamin
• Format: Article
• Language: English
• Subjects: Ablation; Aged; Aged, 80 and over; Alcohols; Anesthesia; Anticoagulants; Calcification; Calcinosis - surgery; Cardiac arrhythmia; Cardiac Catheterization; Cardiology; Catheters; Congestive heart failure; Disruption; Echocardiography; Endocarditis; Feasibility studies; Female; Fluoroscopy; Grooves; Heart attacks; Heart failure; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - methods; Heart valves; Hospitalization; Hospitals; Humans; Hypertension; Implantation; Male; Medical equipment; mitral annular calcification; Mitral valve; Mitral Valve - surgery; mitral valve replacement; Mortality; Ostomy; Patients; Prostheses; Regurgitation; Risk groups; Severity of Illness Index; Stroke; Surgery; Thoracic surgery; transcatheter; Ventricle
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2019.07.069

Treatment of mitral regurgitation (MR) in the setting of severe mitral annular calcification (MAC) is challenging due to the high risk for fatal atrioventricular groove disruption and significant paravalvular leak. The objective of this study was to evaluate the potential for transcatheter mitral valve replacement in patients with severe MAC using an anatomically designed mitral prosthesis. Nine patients (77 ± 6 years of age; 5 men) were treated with the valve, using transapical delivery performed under general anesthesia and with guidance from transesophageal echocardiography and fluoroscopy. Device implantation was successful with relief of MR in all 9 patients. There were no procedural deaths. In 1 patient, left ventricular outflow tract obstruction occurred due to malrotation of the prosthesis, and successful alcohol septal ablation was performed. During a median follow-up of 12 months (range 1 to 28 months), there was 1 cardiac death, 1 noncardiac death, no other mortality, and no prosthetic dysfunction, and MR remained absent in all treated patients. Rehospitalization for heart failure occurred in 2 patients who did not die subsequently. Clinical improvement with mild or no symptoms occurred in all patients alive at the end of follow-up. Transcatheter mitral valve replacement in severe mitral annular calcification with a dedicated prosthesis is feasible and can result in MR relief with symptom improvement. Further evaluation of this approach for these high-risk patients is warranted. [Display omitted]