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Mitral-valve replacement (MVR) in patients with severe mitral annular calcification can be challenging. Case reports of successful transcatheter MVR in patients at high risk for surgery prompted these investigators to create a global registry of a larger group of patients who had transcatheter MVR with a balloon-expandable valve prosthesis. The current article describes outcomes in the 64 patients (from Europe, North America, and South America).
All patients (mean age, 73) were considered inoperable, with a mean Society of Thoracic Surgeons risk score for 30-day mortality of 14.4%; more than half had prior cardiac surgery. The access approach was transseptal in 41%, transapical in 45%, and open transatrial in 14%. Technical success was achieved in 72% of patients with a mean mitral gradient of 4 mm Hg and calculated mitral-valve area of 2.2 cm2. Procedural complications occurred in 20%, including left ventricular outflow tract obstruction (9%) and valve embolization (6%); conversion to open surgery occurred in 6%. Periprocedural mortality by 30 days was 30%. Stroke occurred in 7%. However, symptoms improved markedly in those who survived.
Guerrero M et al. Transcatheter mitral valve replacement in native mitral valve disease with severe mitral annular calcification: Results from the first multicenter global registry. JACC Cardiovasc Interv 2016 Jul 11; 9:1361. (http://dx.doi.org/10.1016/j.jcin.2016.04.022)
Comment
This registry demonstrates feasibility of transcatheter MVR with a balloon-expandable prosthesis for patients with severe mitral annular calcification who are considered inoperable. Nonetheless, significant complications and a high 30-day mortality might limit this approach. The renewed interest in dedicated devices for transcatheter MVR as well as further experience with current devices should improve this procedure for a variety of mitral-valve disease patients at high surgical risk. These developments will be exciting to watch.