The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Transapical Transcatheter Mitral Valve Implantation in Patients with Prior Aortic Valve Replacement: a feasibility report

DOI: 10.4244/EIJ-D-19-00947

1. University Hospital of Zurich, University of Zurich, Switzerland, Switzerland
2. Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
3. Department of Cardiothoracic Surgery, Oslo University, Oslo, Norway
4. Clinic Pasteur, Toulouse, France
5. University Heart Center, Hamburg, Germany
6. Cardiovascular Surgery Department, Cœur Poumon CHU de Lille, Lille, France
7. Heart Center Bonn, University Hospital, Bonn, Germany
8. Emory Structural Heart and Valve Center, Atlanta, Georgia, USA
9. University Hospital of Zurich, University of Zurich, Switzerland. Cardiance Clinic, Pfäffikon, Switzerland. University of Bern, Switzerland

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Transcatheter mitral valve implantation (TMVI) has recently emerged as a treatment option for selected high-risk patients with symptomatic mitral regurgitation (MR). Although feasibility of TMVI in patients with previous aortic valve (AV) prostheses has ben reported1, the interaction between a TMVI and AV prosthesis has not previously been well-characterized. In particular, the risk of LVOT obstruction after TMVI may be higher in patients with a preexisting aortic valve prosthesis, due to the presence of concomitant left ventricular (LV) hypertrophy. Moreover, the frame of the aortic prosthesis can extend into the LVOT and the anchoring mechanism of TMVI may interfere with the normal functioning of an aortic prosthesis. Consequently, the presence of an aortic prosthesis has been considered a relative contraindication to TMVI in these patients and represented an exclusion criterion in most of TMVI early feasibility trials.
The Tendyne™ mitral valve system (Abbott Structural, Santa Clara, California) is a fully retrievable and repositionable TMVI system, which consists of a circular inner frame with porcine pericardial leaflets mounted on a self-expanding outer frame and is anchored via tether to an epicardial pad through apical access

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