title: Iterative Learning of Transcatheter Mitral Valve Replacement in Mitral Valve Annulus Calcification: Management and Prevention of Transcatheter Mitral Valve Replacement Dislocation.
abstract: Transcatheter mitral valve replacement using balloon-expandable valves is an emerging technique for the treatment of patients with significant mitral regurgitation who have been judged to be inoperable owing to significant mitral valve annulus calcification. Although initial reports have been promising, there remains a lack of consensus as to how to plan for transcatheter mitral valve replacement deployment in terms of appropriateness, sizing, and positioning to mitigate the risks of valve displacement and paravalvular regurgitation. We describe two cases of transcatheter mitral valve replacement in patients with significant mitral valve annulus calcification. The first was complicated by valve displacement into the left atrium, which was successfully managed by surgical redeployment and fixation. The second case was thereafter performed successfully using iterative learning and the application of specific preprocedural planning techniques acquired from a root cause analysis of the first case. We describe our experience with both cases and the specific planning principles required to prevent transcatheter mitral valve replacement displacement in patients with mitral valve annulus calcification.
authors.affiliation: Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases, Medical Faculty of the Slovak Health University, Bratislava, Slovakia.
authors.forename: Michal
authors.initials: M
authors.lastname: Hulman
authors.affiliation: Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases, Medical Faculty of the Slovak Health University, Bratislava, Slovakia.
authors.forename: Martin
authors.initials: M
authors.lastname: Bena
authors.affiliation: Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases, Medical Faculty of the Slovak Health University, Bratislava, Slovakia. Electronic address: panayiotisartemiou@yahoo.com.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Artemiou
authors.affiliation: Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases, Medical Faculty of the Slovak Health University, Bratislava, Slovakia.
authors.forename: Ivo
authors.initials: I
authors.lastname: Gasparovic
authors.affiliation: Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases, Medical Faculty of the Slovak Health University, Bratislava, Slovakia.
authors.forename: Vladan
authors.initials: V
authors.lastname: Hudec
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Ronak
authors.initials: R
authors.lastname: Rajani
authors.affiliation: Department of Cardiology and Cardiothoracic Surgery, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Vinayak
authors.initials: V
authors.lastname: Bapat
mesh_terms: D000328:Adult; D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D001705:Bioprosthesis; D002114:Calcinosis / Q000473:pathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007858:Learning; D008297:Male; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D011474:Prosthesis Design; D020127:Recovery of Function; D012306:Risk; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome