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Transcatheter Mitral Valve Replacement in Native Mitral Valve Disease With Severe Mitral Annular Calcification: Results From the First Multicenter Global Registry

Monday, July 25, 2016

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Source Name: JACC: Cardiovascular Interventions


Guerrero M, Dvir D, Himbert D, Urena M, Eleid M, Wang DD, Greenbaum A, Mahadevan VS, Holzhey D, O'Hair D, Dumonteil N, Rodés-Cabau J, Piazza N, Palma JH, DeLago A, Ferrari E, Witkowski A, Wendler O, Kornowski R, Martinez-Clark P, Ciaburri D, Shemin R, Alnasser S, McAllister D, Bena M, Kerendi F, Pavlides G, Sobrinho JJ, Attizzani GF, George I, Nickenig G, Fassa AA, Cribier A, Bapat V, Feldman T, Rihal C, Vahanian A, Webb J, O'Neill W.

The authors describe their findings in a multicenter retrospective review of clinical outcomes in 64 patients with severe mitral annular calcification considered poor candidates for traditional surgical mitral valve replacement, undergoing transcatheter mitral valve implantation with a balloon expandable prosthesis. There were procedural complications in 13 patients (20%): LVOT obstruction in 6, embolization in 4 and perforation in 3 cases. Periprocedural death occurred in 19 patients (29.7%). Most survivors reported significant improvement of symptoms. At 30 days, 21 of the 25 patients (84%) with 30-day clinical follow-up data were in NYHA functional class I or II.

The authors concluded that transcatheter mitral valve implantation with balloon-expandable valves designed for aortic position is feasible in this extremely high-risk patient population. Technical success was achieved in most patients. Although there were important complications and a high 30-day mortality, these results are encouraging considering this represents the first human experience with a transcatheter heart valve not designed for the mitral position and used in an extremely high-risk patient population.

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