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Percutaneous Transvenous Transseptal Transcatheter Valve Implantation in Failed Bioprosthetic Mitral Valves, Ring Annuloplasty, and Severe Mitral Annular Calcification. JACC Cardiovasc Interv 2016 Jun 13;9(11):1161-74



Pubmed ID




Scopus ID

2-s2.0-84963622248 (requires institutional sign-in at Scopus site)   100 Citations


OBJECTIVES: 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.

BACKGROUND: Surgical mitral valve replacement in patients with previous surgery or severe mitral annular calcification (MAC) is often associated with high or prohibitive risk.

METHODS: 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).

RESULTS: 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.

CONCLUSIONS: 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.

Author List

Eleid MF, Cabalka AK, Williams MR, Whisenant BK, Alli OO, Fam N, Pollak PM, Barrow F, Malouf JF, Nishimura RA, Joyce LD, Dearani JA, Rihal CS

MESH terms used to index this publication - Major topics in bold

Aged, 80 and over
Cardiac Catheterization
Disease-Free Survival
Echocardiography, Doppler, Color
Echocardiography, Three-Dimensional
Echocardiography, Transesophageal
Feasibility Studies
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Mitral Valve
Mitral Valve Annuloplasty
Mitral Valve Insufficiency
Prosthesis Design
Prosthesis Failure
Radiography, Interventional
Recovery of Function
Risk Factors
Time Factors
Treatment Outcome
United States