Transcatheter aortic valve replacement (TAVR) has gained worldwide acceptance for the treatment of aortic stenosis in high risk patients. Interestingly, transcatheter mitral valve repair (TMVR) is in the initial phase with reduced implantations. One of the reasons for the difference in acceptance of the two approaches is the complex anatomy of the native mitral valve compared to the aortic valve. For redo patients with previous annular rings or bioprosthetic valves, the surgical anatomy seems more favorable for TMVR, especially in patients with high PASP who are poor candidates for redo surgery.
In the following video, the authors show an Edwards SAPIEN 3 TMVR valve-in-valve implanted through the apical Certitude delivery system. The patient was an 81-year-old female who presented with a severe mitral insufficiency. Her past medical history revealed a 2009 mitral valve replacement with a 27 mm Mosaic bioprosthetic valve. Both TTE and TOE showed a ruptured cusp and an impaired LVF of 50%. A CT scan showed an enlarged left atrium. The patient was contraindicated for surgery and the heart team decided to give her an apical TMVR.
The patient was positioned supine and prepared as usual. A surgical apical approach was done in the standard fashion. An 18 Fr apical Certitude delivery system was inserted and an Edwards SAPIEN 3 26 mm valve was implanted under rapid pacing. The final result was optimal with no mitral regurgitation and with a mean gradient of 4 mmHg. The patient had an uneventful postoperative outcome and was discharged home on postoperative day seven.
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