title: Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification.
abstract: This study sought to examine the feasibility, safety, and intermediate-term outcomes in patients undergoing percutaneous transvenous transcatheter mitral valve implantation in failed bioprosthesis, ring annuloplasty, and calcific mitral stenosis.
  
  
  
  Surgical mitral valve replacement in patients with previous surgery or severe mitral annular calcification (MAC) is often associated with high or prohibitive risk.
  
  
  
  Percutaneous transfemoral antegrade transseptal implantation of Edwards SAPIEN prosthesis (Edwards Lifesciences, Irvine, California) was performed in 48 patients with degenerated mitral bioprosthesis (n = 33), previous ring annuloplasty (n = 9), and severe MAC (n = 6).
  
  
  
  The mean Society of Thoracic Surgeons risk score was 13.2 ± 7.4% with a mean age 76 ± 11 years. Acute procedural success was achieved in 42 of 48 patients (88%) in the overall group and 31 of 33 (94%) in the failed bioprosthetic mitral valve group and success rate of 11 of 15 (73%) in patients with failed annuloplasty rings and MAC. After successful procedure, no patients had > mild residual mitral prosthetic or periprosthetic regurgitation; mean transvalvular gradients were 6 ± 2.5 mm Hg. Thirty-day survival free of death and cardiovascular surgery was 85% in the overall group and 91% in the failed bioprosthetic mitral valve subgroup.
  
  
  
  Transfemoral percutaneous transvenous mitral valve implantation in high-risk patients with degenerated bioprosthesis is safe, effective, and associated with rapid improvement in hemodynamics, short length of stays, and improved functional status. Percutaneous mitral valve implantation in patients with failed annuloplasty rings and severe MAC is a promising therapy with significant short-term morbidity and mortality that requires further study.
authors.affiliation: Department of Cardiovascular Diseases and Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mackram F
authors.initials: MF
authors.lastname: Eleid
authors.affiliation: Department of Cardiovascular Diseases and Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Allison K
authors.initials: AK
authors.lastname: Cabalka
authors.affiliation: Division of Cardiovascular Diseases, New York University Medical Center, New York, New York.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Williams
authors.affiliation: Division of Cardiovascular Diseases, Intermountain Heart Institute, Salt Lake City, Utah.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Whisenant
authors.affiliation: Division of Cardiovascular Diseases, University of Alabama, Birmingham, Alabama.
authors.forename: Oluseun O
authors.initials: OO
authors.lastname: Alli
authors.affiliation: Division of Cardiovascular Diseases, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Fam
authors.affiliation: Department of Cardiovascular Diseases and Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Pollak
authors.affiliation: Division of Cardiovascular Diseases, New York University Medical Center, New York, New York.
authors.forename: Firas
authors.initials: F
authors.lastname: Barrow
authors.affiliation: Department of Cardiovascular Diseases and Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Malouf
authors.affiliation: Department of Cardiovascular Diseases and Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rick A
authors.initials: RA
authors.lastname: Nishimura
authors.affiliation: Department of Cardiovascular Diseases and Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lyle D
authors.initials: LD
authors.lastname: Joyce
authors.affiliation: Department of Cardiovascular Diseases and Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.affiliation: Department of Cardiovascular Diseases and Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: rihal@mayo.edu.
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D018572:Disease-Free Survival; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D009864:Ontario; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015641:Radiography, Interventional; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: mitral valve implantation; percutaneous; transcatheter valve; transseptal