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Transapical aortic valve implantation after previous mitral valve surgery.
MedLine Citation:
PMID:  20884026     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: Transcatheter aortic valve implantation is a new method for treatment of very high-risk patients with aortic valve stenosis. Especially in patients who have had previous cardiac surgery, the operative risk can be reduced. Nevertheless, this new procedure has some potential risks in patients with previous mitral valve surgery, owing to the increased risk by direct contact between the 2 valves with inhibition of mechanical mitral leaflet mobility, in view of potential mitral annulus pressure or leaflet damage caused by transcatheter wires.
METHODS: Between April 2008 and April 2010, 217 consecutive patients (mean EuroSCORE: 40% ± 20%; mean Society of Thoracic Surgeons mortality score: 21 ± 17%; mean age: 79 ± 9 years, 67 men, 150 women) underwent transapical aortic valve implantation. In 6 patients a previous mitral operation (1 valve reconstruction, 5 valve replacements) had been performed.
RESULTS: In all 6 patients the aortic valve could be implanted by the transapical approach, and the procedure was successful. In 2 patients the heart-lung machine was used electively owing to low ejection fraction (10% and 15%). In 2 patients there was slight paravalvular leakage of the aortic prosthesis. Neither increased mitral valve regurgitation nor mitral leaflet damage was observed. One patient had endocarditis develop 8 months postoperatively and another with severe reduced left ventricular function died early postoperatively.
CONCLUSIONS: Transcatheter valve implantation can be performed successfully after previous mitral valve surgery. Particular care should be taken to achieve optimal valve positioning and not to damage mitral leaflets during manipulation with guide wires.
Authors:
Thorsten Drews; Miralem Pasic; Semih Buz; Axel Unbehaun; Stephan Dreysse; Marian Kukucka; Alexander Mladenow; Roland Hetzer
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Publication Detail:
Type:  Journal Article     Date:  2010-09-29
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  142     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  84-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Deutsches Herzzentrum Berlin, Berlin, Germany.
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