Echocardiographic findings of transcatheter mitral valve-in-valve therapy vs. Re-do surgical MVR in patients with previous mitral prosthetic valves

BACKGROUND Adequacy of echocardiographic findings and clinical outcome after transcatheter mitral valve-in-valvereplacement for degenerative bioprosthesis is not fully understood. METHODS We retrospectively identified patients who underwent mitral valve replacement via either surgical or transcatheter for degenerative mitralbioprosthesis at three US institution. We compared echocardiographic findings and clinical outcome of patientswho had mitral valve-in-valve with those of patients who underwent second surgical mitral valve replacement. RESULTS 58 patients underwent transcatheter mitral valve replacement (TMVR) and 57 patients underwent surgicalmitral valve replacement (SMVR). Mean age and the Society of Thoracic Surgeons- Predicted Risk of Mortality (STS-PROM) were significantly higher in patients with TMVR than in those with SMVR (Age 74.8±11.1years vs 65.9±14.2years, P=0.002; STS-PROM 13.6±8.2% vs 8.9±9.8%, P\u3c0.0001, respectively). Although mean transmitral pressure gradient (MPG) tended to be higher in the TMVR group (6.5±2.8 vs 5.3±2.5, P=0.03), mitral valve area (MVA) and mitralregurgitation grade at discharge were similar between the TMVR group and SMVR group (MVA 2.6±0.8 vs 3.0±1.2, P=0.47; MR (≥mild) 9.6% vs 10.3%, P=0.92, respectively), achieving similar 1-year survival rate (TMVR 83.5% vs SMVR 76.9%, P=0.23). (Figure presented) CONCLUSION Echocardiographic findings after TMVR for degenerative mitral bioprosthesis were acceptable when compared withthose after SMVR, achieving similar one-year survival between the TMVR and the SMVR group

Transcatheter aortic valve implantation: role of multi-detector row computed tomography to evaluate prosthesis positioning and deployment in relation to valve function

AIMS: Aortic regurgitation after transcatheter aortic valve implantation (TAVI) is one of the most frequent complications. However, the underlying mechanisms of this complication remain unclear. The present evaluation studied the anatomic and morphological features of the aortic valve annulus that may predict aortic regurgitation after TAVI. METHODS AND RESULTS: In 53 patients with severe aortic stenosis undergoing TAVI, multi-detector row computed tomography (MDCT) assessment of the aortic valve apparatus was performed. For aortic valve annulus sizing, two orthogonal diameters were measured (coronal and sagittal). In addition, the extent of valve calcifications was quantified. At 1-month follow-up after procedure, MDCT was repeated to evaluate and correlate the prosthesis deployment to the presence of aortic regurgitation. Successful procedure was achieved in 48 (91%) patients. At baseline, MDCT demonstrated an ellipsoid shape of the aortic valve annulus with significantly larger coronal diameter when compared with sagittal diameter (25.1 +/- 2.4 vs. 22.9 +/- 2.0 mm, P < 0.001). At follow-up, MDCT showed a non-circular deployment of the prosthesis in six (14%) patients. Moderate post-procedural aortic regurgitation was observed in five (11%) patients. These patients showed significantly larger aortic valve annulus (27.3 +/- 1.6 vs. 24.8 +/- 2.4 mm, P = 0.007) and more calcified native valves (4174 +/- 1604 vs. 2444 +/- 1237 HU, P = 0.005) at baseline and less favourable deployment of the prosthesis after TAVI. CONCLUSION: Multi-detector row computed tomography enables an accurate sizing of the aortic valve annulus and constitutes a valuable imaging tool to evaluate prosthesis location and deployment after TAVI. In addition, MDCT helps to understand the underlying mechanisms of post-procedural aortic regurgitation