Mitral implant of the Inovare transcatheter heart valve in failed surgical bioprostheses: a novel alternative for valve-in-valve procedures

Mitral implant of the Inovare transcatheter heart valve in failed surgical bioprostheses: a novel alternative for valve-in-valve procedures

Author Gaia, Diego Felipe Autor UNIFESP Google Scholar
Braz, Ademir Massarico Autor UNIFESP Google Scholar
Simonato, Matheus Autor UNIFESP Google Scholar
Dvir, Danny Google Scholar
Breda, Joao Roberto Autor UNIFESP Google Scholar
Ribeiro, Gustavo Calado Google Scholar
Ferreira, Carolina Baeta Autor UNIFESP Google Scholar
Marcondes Souza, Jose Augusto Autor UNIFESP Google Scholar
Buffolo, Enio Autor UNIFESP Google Scholar
Palma, Jose Honorio Autor UNIFESP Google Scholar
Abstract OBJECTIVES: Reoperative procedure for the treatment of a failed mitral bioprosthesis is associated with considerable risk. In some cases, mortality is high and might contraindicate the benefit of the procedure. The minimally invasive valve-in-valve (ViV) transcatheter mitral valve implant offers an alternative less-invasive approach, reducing morbidity and mortality. The objective of this paper was to evaluate the mitral ViV approach using the Braile Inovare prosthesis. METHODS: The transcatheter balloon-expandable Braile Inovare prosthesis was used in 12 cases. Procedures were performed in a hybrid operating room, under fluoroscopic and echocardiographic control. Through left minithoracotomy, the prostheses were implanted through the cardiac apex. Serial echocardiographic and clinical examinations were performed. Follow-up varied from 1 to 30 months. RESULTS: A total of 12 transapical mitral ViV procedures were performed. Patients had a mean age of 61.6 +/- 9.9 years and 92% were women. Mean logistic EuroSCORE was 20.1%. Successful valve implantation was possible in all cases. In one case, a right lateral thoracotomy was performed for the removal of an embolized prosthesis. There was no operative mortality. Thirty-day mortality was 8.3%. Ejection fraction was preserved after the implant (66.7%

64.8%

P = 0.3). The mitral gradient showed a significant reduction (11 mmHg

6 mmHg

P < 0.001). Residual mitral regurgitation was not present. There was no left ventricular outflow tract obstruction. CONCLUSIONS: The mitral ViV implant in a failed bioprosthesis is an effective procedure. This possibility might alter prosthesis selection in the future initial surgical prosthesis selection, favouring bioprostheses. Further large trials should explore its safety.
Keywords Mitral valve
Cardiopulmonary bypass
Cardiac catheterization
xmlui.dri2xhtml.METS-1.0.item-coverage Oxford
Language English
Date 2017
Published in Interactive Cardiovascular And Thoracic Surgery. Oxford, v. 24, n. 4, p. 514-520, 2017.
ISSN 1569-9293 (Sherpa/Romeo, impact factor)
Publisher Oxford Univ Press
Extent 514-520
Origin http://dx.doi.org/10.1093/icvts/ivw368
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000404043800006
URI https://repositorio.unifesp.br/handle/11600/54782

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