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Transcatheter mitral valve implantation via transapical approach: an early experience

Selected in European Journal of Cardio-Thoracic Surgery by R.L.J. Osnabrugge

References

Authors

Sondergaard L, Brooks M, Ihlemann N, Jonsson A, Holme S, Tang M, Terp K, Quadri A

Reference

Eur J Cardiothorac Surg. 2015 Dec;48(6):873-8

Published

December 2015

Link

Read the abstract

Background

According to the Euro Heart Study, almost 50% of patients with symptomatic severe mitral regurgitation (MR) are not referred to surgery. Transcatheter mitral valve replacement (TMVI) could advance into an acceptable alternative for these patients, but only a small series of compassionate cases are available. 

Major findings

  • Three elderly patients with severe mitral valve regurgitation (MR), class IV heart failure, severe comorbidities and a Society of Thoracic Surgeons (STS) mortality score>22% were treated transapically with a CardiAQ mitral valve prosthesis.
  • Accurate positioning and deployment was achieved in all three cases, resulting in immediate elimination of the MR.
  • All three patients were extubated.
  • Two of the patients recovered fully and were discharged home while the third patient died after 9 days due to hospital acquired pneumonia.

My comments

This study shows that transapical TMVI is feasible in high-risk patients. However, the field is still in a very early phase. Mitral valve surgery for secondary MR has the advantage of direct visualization and applies complex techniques including leaflet plasty, leaflet resection, neochordae and annuloplasty. Nevertheless, MR recurrence after surgery can be high. Therefore, the path for TMVI will be challenging. On the other hand the current early study shows the technique is feasible and technically simpler than transcatheter MV repair. TMVI might provide a durable solution for many patients in the future. Well-designed clinical trials are needed to demonstrate the clinical benefit of this exciting new technology.

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