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25.05.2019 | Original Article | Ausgabe 1/2020

General Thoracic and Cardiovascular Surgery 1/2020

Early outcomes of transcatheter mitral valve replacement for degenerated bioprosthesis in Japanese (MITRAL VIV study): a four-case series

Zeitschrift:
General Thoracic and Cardiovascular Surgery > Ausgabe 1/2020
Autoren:
Kizuku Yamashita, Satsuki Fukushima, Yusuke Shimahara, Atsushi Okada, Makoto Amaki, Hideaki Kanzaki, Chisato Izumi, Satoshi Yasuda, Junjiro Kobayashi, Tomoyuki Fujita
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11748-019-01147-x) contains supplementary material, which is available to authorized users.

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Abstract

Objective

The mitral valve-in-valve procedure has been performed in the world. However, the early clinical outcomes in Japan remain unclear. Hence, we investigated the feasibility, safety, and efficacy in high-risk Japanese patients.

Methods

In May 2017, we launched the present clinical study of the mitral valve-in-valve procedure (MITRAL VIV study). The study enrolled four patients (three women; age range 69–85 years) with severe mitral regurgitation due to a degenerated mitral bioprosthesis. The median Society of Thoracic Surgeons score was 8.8 (range 8.4–9.8)%.

Results

In all patients, the mitral valve-in-valve procedure was successfully performed via a transapical approach at the initial attempt. The median grade of mitral insufficiency improved from grade 4 (range 3–4) to grade 1 (range 0–1) at days 7 and 30. The mean mitral pressure gradient of the median value changed from 7.0 (range 5.0–8.0) mmHg to 5.0 (range 5.0–9.5) mmHg at 7 days and 6.2 (range 4.0–11.0) mmHg at 30 days. The median New York Heart Association functional class improved from 2 (range 2–3) to 1 (range 1–3) at day 7 and to 1 (range 1–2) at day 30. We performed a bit deep implantation intentionally to avoid left ventricular outflow tract obstruction in one patient with a small aorto-mitral-annular angle. Neither mortality nor severe complications were observed at the last follow-up (range 207–513 days).

Conclusions

In our experience, the safe mitral valve-in-valve procedure was feasible with cautious procedures.

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