title: Self-expandable transcatheter aortic valve implantation for aortic stenosis after mitral valve surgery.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation has emerged as a valuable option to treat patients with symptomatic severe aortic stenosis, who are not being considered for surgery because of significant comorbidities. Concerns exist over treating patients who have previously undergone mitral valve surgery for possible interference between the percutaneous aortic valve and the mitral prosthesis or ring.
  
  
  METHODS
  At our centre, from May 2008 to December 2012, 172 patients (76 male) with severe symptomatic aortic stenosis were eligible for transcatheter aortic valve implant. Nine patients, affected by severe aortic stenosis, had previously undergone mitral valve surgery (4 mono-leaflet, 3 bileaflet, 1 bioprosthesis, 1 mitral ring); they were considered high-risk surgical candidates following joint evaluation by cardiac surgeons and cardiologist and had undergone TAVI.
  
  
  RESULTS
  Seven patients underwent standard femoral retrograde CoreValve(®) (Medtronic Inc., Minneapolis, USA) implantation, two patients underwent a direct aortic implantation through a mini-thoracotomy. All patients experienced immediate improvement of their haemodynamic status. No deformation of the nitinol tubing of the CoreValve, nor distortion or malfunction of the mechanical valve or mitral ring, occurred as assessed by echographical and fluoroscopic evaluation. No major postoperative complications occurred. In all patients , echocardiography indicated normal valve function during follow-up.
  
  
  CONCLUSIONS
  Our experience confirms the feasibility of CoreValve implantation in patients with mechanical mitral valves or mitral annuloplasty ring.
authors.affiliation: A De Gasperis Cardiology & Cardiac Surgery Department, Niguarda Ca' Granda Hospital, Milan, Italy. giuseppe.bruschi@fastwebnet.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bruschi
authors.forename: Federico
authors.initials: F
authors.lastname: De Marco
authors.forename: Alberto
authors.initials: A
authors.lastname: Barosi
authors.forename: Paola
authors.initials: P
authors.lastname: Colombo
authors.forename: Luca
authors.initials: L
authors.lastname: Botta
authors.forename: Sandra
authors.initials: S
authors.lastname: Nonini
authors.forename: Luigi
authors.initials: L
authors.lastname: Martinelli
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000295:instrumentation*; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D058386:Mitral Valve Annuloplasty; D061330:Multidetector Computed Tomography; D011474:Prosthesis Design; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic valve; Heart valve; Mechanical; Percutaneous; Replacement; Transapical
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