title: Thrombotic valvular dysfunction with transcatheter mitral interventions for postsurgical failures.
abstract: BACKGROUND
  Degenerated surgical mitral valve repairs or surgical prostheses are currently being treated with transcatheter mitral valve replacement (TMVR). We report the procedural and mid-term assessment of thirteen cases.
  
  
  METHODS
  From 12/2013 to 12/2015, 13 consecutive patients with degenerated mitral valve repair or valve replacement were treated. Patients were assessed for mitral valve academic valve consortium (MVARC) defined outcomes.
  
  
  RESULTS
  Immediate procedural MVARC defined technical success was 92%. At 30 days MVARC device and procedure success were 61% and 84%, respectively. Mean follow-up was 150 days [IQR 40-123 days]. There were 2 late major adverse outcomes, a noncardiac related death (628 days) and a stroke (382 days). The mean mitral gradient decreased from 9.5 ± 3.4 to 5.5 ± 2.6 mm Hg (P < 0.01). Three patients were found to have high gradients, two presented with heart failure while another patient was found to have reduced leaflet motion and abnormal thickening postprocedure. The two patients with heart failure were treated with enoxaparin, which caused subsequent resolution of increased valve gradients in one patient. The other patient could not tolerate prolonged treatment from anticoagulation due to gastrointestinal bleeding. Three of 13 patients were treated with dual-antiplatelet therapy and were suspected to have valve thrombosis.
  
  
  CONCLUSIONS
  Thrombotic related dysfunction post-TMVR occurred in 15% (2/13) of patients and one patient had abnormal leaflet thickening that may have been thrombus related. Dual-antiplatelet therapy was used in all 3 cases suggesting the possible need for oral anticoagulation postmitral valve-in-valve therapy. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Department of Medicine, Henry Ford Health System, Center for Structural Heart Disease, Detroit, Michigan.
authors.forename: Marvin H
authors.initials: MH
authors.lastname: Eng
authors.affiliation: Department of Medicine, Henry Ford Health System, Center for Structural Heart Disease, Detroit, Michigan.
authors.forename: Adam
authors.initials: A
authors.lastname: Greenbaum
authors.affiliation: Department of Medicine, Henry Ford Health System, Center for Structural Heart Disease, Detroit, Michigan.
authors.forename: Dee Dee
authors.initials: DD
authors.lastname: Wang
authors.forename: Janet
authors.initials: J
authors.lastname: Wyman
authors.affiliation: Department of Medicine, Henry Ford Health System, Center for Structural Heart Disease, Detroit, Michigan.
authors.lastname: Dnp
authors.affiliation: Department of Medicine, Henry Ford Health System, Center for Structural Heart Disease, Detroit, Michigan.
authors.forename: Heider
authors.initials: H
authors.lastname: Arjomand
authors.affiliation: Department of Medicine, Henry Ford Health System, Center for Structural Heart Disease, Detroit, Michigan.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Yadav
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Health System, Detroit, Michigan.
authors.forename: Hassan
authors.initials: H
authors.lastname: Nemeh
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Health System, Detroit, Michigan.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
authors.affiliation: Cardiac Structural Interventions, NorthShore University Health System, Detroit, Michigan.
authors.forename: Mayra
authors.initials: M
authors.lastname: Guerrero
authors.affiliation: Department of Medicine, Henry Ford Health System, Center for Structural Heart Disease, Detroit, Michigan.
authors.forename: William
authors.initials: W
authors.lastname: O'Neill
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008824:Michigan; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D011475:Prosthesis Failure; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: mitral; transapical; transcatheter heart valve; valve thrombosis; valve-in-valve