eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
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2/2020
vol. 16
 
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abstract:
Original paper

Transcatheter aortic valve replacement in patients with previous mitral valve replacement. A systematic study

Zbigniew Chmielak
1
,
Maciej Dąbrowski
1
,
Paweł Tyczyński
1
,
Krzysztof Kukuła
1
,
Ilona Michałowska
1
,
Emilia Szudejko
1
,
Jarosław Skowroński
1
,
Mariusz Kuśmierczyk
1
,
Adam Witkowski
1

  1. Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
Adv Interv Cardiol 2020; 16, 2 (60): 177–183
DOI: https://doi.org/10.5114/aic.2020.96061
Online publish date: 2020/06/23
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Introduction
Severe aortic stenosis (AS) is an ever-growing healthcare problem in ageing populations. Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of AS. However, TAVI in patients who have undergone mitral valve replacement (MVR) is associated with increased risk of mitral valve damage. Limited data exist on TAVI in patients with AS who underwent MVR in the past.

Aim
To retrospectively assess the clinical characteristics, detailed echocardiographic and computed tomography measurements, procedural and in-hospital outcome as well as any valve intervention or major adverse cardiovascular events according to VARC-2 criteria at follow-up of patients with a history of MVR, who underwent TAVI.

Material and methods
Seventeen patients with a history of mitral valve operation, in whom TAVI was performed between 2010 and 2018, were identified. Of these, 15 underwent previous MVR.

Results
Overall, TAVI resulted in a decrease of mean transaortic gradient by 38.3 ±14 mm Hg (p < 0.001) and a decrease of maximal transaortic gradient by 58.6 ±27.6 mm Hg (p < 0.001). A successful immediate result was obtained in 14 (93.3%) patients. One tamponade occurred during TAVI, which was successfully treated with pericardiocentesis. Post-procedurally, no significant changes in transmitral gradients or mitral regurgitations were observed. Two patients died after hospital discharge, one due to possible internal bleeding and the other due to infection.

Conclusions
TAVI in patients after MVR is feasible. Meticulous preinterventional echocardiographic and computed tomography planning is essential. Although recommended in previous reports, TEE guidance may not necessarily be obligatory during the procedure.

keywords:

transcatheter aortic valve implantation, transcatheter aortic valve implantation complications, mitral valve replacement
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