title: Short-term results of transapical transcatheter mitral valve implantation for mitral regurgitation.
abstract: BACKGROUND
  Mitral regurgitation (MR) is the most common valvular heart disease, and mitral valve surgery is the gold standard therapy for severe MR. Many patients with severe MR are not referred for surgery because of old age, comorbidities, or severe left ventricular dysfunction. Transcatheter mitral valve implantation may be a better therapeutic option for these high-risk patients with severe symptomatic MR.
  
  
  OBJECTIVE
  This study sought to describe the first-in-man series of transapical mitral valve implantation for mitral regurgitation with the TIARA device.
  
  
  METHODS
  Extensive preclinical ex vivo and animal studies were conducted with the transapical mitral valve implantation of the Tiara system. The first 2 cases of human implantation were successfully performed in a 73-year-old man and a 61-year-old woman with severe functional MR. Both patients were in New York Heart Association class IV heart failure with depressed left ventricular ejection fraction, pulmonary hypertension, and additional comorbidities.
  
  
  RESULTS
  The valve was implanted uneventfully in both patients. General anesthesia and transapical access were used. Patients were hemodynamically stable with no need for cardiopulmonary bypass. Immediately after implantation, systemic arterial pressure and stroke volume increased and pulmonary pressure decreased dramatically. There were no intraoperative complications, and both patients were extubated in the operating room. Post-procedural echocardiograms at 48 h, 1 month, and 2 months demonstrated excellent prosthetic valve function with a low transvalvular gradient and no left ventricular outflow tract obstruction. There was a trivial paravalvular leak in the first patient at 48 h, which was completely resolved at subsequent studies; no paravalvular leak occurred in the second patient.
  
  
  CONCLUSIONS
  Transapical transcatheter mitral valve implantation is technically feasible and can be performed safely. Early hemodynamic performance of the prosthesis was excellent. Transcatheter mitral valve implantation may become an important treatment option for patients with severe MR who are at high operative risk.
authors.affiliation: Division of Cardiothoracic Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: acheung@providencehealth.bc.ca.
authors.forename: Anson
authors.initials: A
authors.lastname: Cheung
authors.affiliation: Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Webb
authors.affiliation: Interventional Cardiology, ZNA Middelheim Hospital, Antwerp, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: Verheye
authors.affiliation: Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Moss
authors.affiliation: Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Boone
authors.affiliation: Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Department of Anesthesiology and Pharmacology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Ron
authors.initials: R
authors.lastname: Ree
authors.affiliation: Interventional Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Banai
mesh_terms: D000368:Aged; D001705:Bioprosthesis / Q000009:adverse effects; D015897:Comorbidity; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011474:Prosthesis Design; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology
keywords: mitral regurgitation; mitral valve replacement; mitral valve implantation; transapical; transcatheter