Mitral implant of the Inovare transcatheter heart valve in failed surgical bioprostheses: a novel alternative for valve-in-valve procedures

Abstract OBJECTIVES: Reoperative procedure for the treatment of a failed mitral bioprosthesis is associated with considerable risk. In some cases, mortality is high and might contraindicate the benefit of the procedure. The minimally invasive valve-in-valve (ViV) transcatheter mitral valve implant o...

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Published in:Interactive cardiovascular and thoracic surgery 2017-04, Vol.24 (4), p.514-520
Main Authors: Gaia, Diego Felipe, Braz, Ademir Massarico, Simonato, Matheus, Dvir, Danny, Breda, João Roberto, Ribeiro, Gustavo Calado, Ferreira, Carolina Baeta, Souza, José Augusto Marcondes, Buffolo, Enio, Palma, José Honório
Format: Article
Language:English
Subjects:
Aged
Bioprosthesis
Cardiac Catheterization
Female
Heart Valve Diseases - surgery
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - methods
Humans
Male
Middle Aged
Mitral Valve
Prosthesis Design
Reoperation
Risk Factors
Time Factors
Treatment Outcome
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Summary:Abstract OBJECTIVES: Reoperative procedure for the treatment of a failed mitral bioprosthesis is associated with considerable risk. In some cases, mortality is high and might contraindicate the benefit of the procedure. The minimally invasive valve-in-valve (ViV) transcatheter mitral valve implant offers an alternative less-invasive approach, reducing morbidity and mortality. The objective of this paper was to evaluate the mitral ViV approach using the Braile Inovare prosthesis. METHODS: The transcatheter balloon-expandable Braile Inovare prosthesis was used in 12 cases. Procedures were performed in a hybrid operating room, under fluoroscopic and echocardiographic control. Through left minithoracotomy, the prostheses were implanted through the cardiac apex. Serial echocardiographic and clinical examinations were performed. Follow-up varied from 1 to 30 months. RESULTS: A total of 12 transapical mitral ViV procedures were performed. Patients had a mean age of 61.6 ± 9.9 years and 92% were women. Mean logistic EuroSCORE was 20.1%. Successful valve implantation was possible in all cases. In one case, a right lateral thoracotomy was performed for the removal of an embolized prosthesis. There was no operative mortality. Thirty-day mortality was 8.3%. Ejection fraction was preserved after the implant (66.7%; 64.8%; P = 0.3). The mitral gradient showed a significant reduction (11 mmHg; 6 mmHg; P 
ISSN:1569-9293
1569-9285
DOI:10.1093/icvts/ivw368