title: Transcatheter mitral valve implantation via transapical approach: an early experience.
abstract: OBJECTIVE
  As many as 50% of patients with severe symptomatic mitral valve regurgitation are denied surgical valve replacement or repair due to high operative risk. We describe an early series of cases of transcatheter implantation with a CardiAQ™ mitral valve via a transapical approach.
  
  
  METHODS
  Three consecutive patients with an Society of Thoracic Surgeons (STS) mortality score of >22% were selected for transcatheter mitral valve implantation (TMVI) on compassionate grounds. All patients were elderly, had severe mitral regurgitation (MR), were in Class IV heart failure and deemed unsuitable for the MitraClip. Two of the patients had functional MR in the setting of ischaemic cardiomyopathy with left ventricular ejection fraction (LVEF) <40%, deemed while the remaining patient had chordal rupture with extensive anterior leaflet flail (preserved LVEF). Comorbidities included previous coronary artery bypass surgery (n = 2), severe pulmonary hypertension (n = 1) and moderate to severe chronic renal failure (n = 3). A CardiAQ mitral valve was implanted using fluoroscopy and transoesophageal (TEE) guidance via a standard transapical approach.
  
  
  RESULTS
  Accurate prosthesis positioning and deployment with immediate elimination of the MR was achieved in all 3 cases. Two patients made full clinical recovery and were discharged home. Post-procedural TEE performed on Days 1, 30 and 60 days showed good valve function, stable valve position and minimal LVOT gradient. One patient expired on the postoperative day 9 due to pneumonia.
  
  
  CONCLUSIONS
  TMVI using the CardiAQ™ device via a transapical approach is feasible and effective.
authors: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark lars.soendergaard.01@regionh.dk.
authors: Lars
authors: L
authors: Sondergaard
authors: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors: Matthew
authors: M
authors: Brooks
authors: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors: Nikolaj
authors: N
authors: Ihlemann
authors: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors: Anders
authors: A
authors: Jonsson
authors: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors: Susanne
authors: S
authors: Holme
authors: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors: Mariann
authors: M
authors: Tang
authors: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors: Kim
authors: K
authors: Terp
authors: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors: Arshad
authors: A
authors: Quadri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D016896:Treatment Outcome
keywords: Minimally invasive cardiac surgery; Valve disease