Mitral implant of the Inovare transcatheter heart valve in failed surgical bioprostheses: a novel alternative for valve-in-valve procedures
Data
2017
Autores
Gaia, Diego Felipe 
Braz, Ademir Massarico
Simonato, Matheus
Breda, Joao Roberto
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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.
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.
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Interactive Cardiovascular And Thoracic Surgery. Oxford, v. 24, n. 4, p. 514-520, 2017.