Transcatheter valve-in-valve implantation treatment for mitral bioprosthesis deterioration: short-term follow-up_West China Medical Journal

Authors：

 ZHANG Haibo ¹ , MENG Xu ¹ , WANG Shengxun ¹ , ZHENG Shuai ¹ , MENG Fei ¹ , WU Kaisheng ¹ , LIU Wei ² , ZHOU Yujie ²

1. Cardiac Surgery Department, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;
2. Cardiology Department, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding?author：

ZHANG Haibo, Email: zhanghb2318@163.com

Keywords：

Mitral valve; Bioprosthesis deterioration; Transcatheter technique; Valve-in-valve technique

DOI：

10.7507/1002-0179.202008175

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Objective To explore the short-term follow-up clinical effect of transcatheter valve-in-valve implantation treatment for mitral bioprosthesis deterioration.Methods The single center data of elderly patients with mitral valve bioprosthetic dysfunction who received transapical J-Valve intervention between January 2019 and May 2020 were reviewed and summarized. After the informed consent was signed, single lumen endotracheal intubation was performed under general anesthesia in hybrid operating room. The left intercostal small incision was used to explore the apical area. Fluoroscopy and three-dimensional esophageal ultrasound were used to guide the puncture needle. Then the guide wire entered the left atrium through the mitral valve biological valve. The catheter was exchanged, and the rigid support wire was exchanged. The reverse loaded J-Valve system was guided and implanted into the biological mitral valve with beating heart. The appropriate implantation depth was adjusted, and stent valve was released under rapid pacing. Post balloon dilation of the valve was performed if necessary.Results From January 2019 to May 2020, transcatheter J-Valve implantation was completed in 20 patients with mitral valve dysfunction and high-risk evaluation of routine thoracotomy and cardiopulmonary bypass (the Society of Thoracic Surgeon score above 6). In terms of the type of the the mitral bioprosthesis, there were 6 cases of Hancock valves, 7 cases of Perimount valves, 6 cases of Epic valves, and 1 case of Baxiter valve. In terms of the size of the the mitral bioprosthesis, there were 2 cases of size 29 valves, 11 cases of size 27 valves, and 7 cases of size 25 valves. One valve fell into the left ventricle at early stage. One patient had mild valve displacement during operation, and a second valve was implanted at the same time. The success rate of valve-in-valve implantation was 95%. The length of stay in intensive care unit was less than 6 h in 5 cases, 6-24 h in 13 cases, 24-48 h in 1 case, and more than 48 h in 1 case. No patient’s postoperative mitral regurgitation was moderate or above. The mean mitral valve pressure gradient was (5.2±2.3) mm Hg (1 mm Hg=0.133 kPa). Patients recovered well after the valve-in-valve implantation treatment, with no death within postoperative one month. One patient died of infection and multiple organ failure during follow-up after one month. Other patients recovered smoothly without serious complications.Conclusions The clinical effect of J-Valve intervention in the treatment of mitral valve bioprosthetic dysfunction through apical approach is good. The implantation can be completed under beating heart, avoiding cardiopulmonary bypass and routine thoracotomy cardiac arrest, which is worthy of further observation and follow-up.

Citation： ZHANG Haibo, MENG Xu, WANG Shengxun, ZHENG Shuai, MENG Fei, WU Kaisheng, LIU Wei, ZHOU Yujie. Transcatheter valve-in-valve implantation treatment for mitral bioprosthesis deterioration: short-term follow-up. West China Medical Journal, 2020, 35(9): 1108-1112. doi: 10.7507/1002-0179.202008175 Copy

1.	孟旭, 白濤. 5066 例瓣膜手術的圍術期臨床回顧. 中華胸心血管外科雜志, 2007, 23(1): 11-13.
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3.	Barbanti M, Costa G, Zappulla P, et al. Incidence of long-term structural valve dysfunction and bioprosthetic valve failure after transcatheter aortic valve replacement. J Am Heart Assoc, 2018, 7(15): e008440.
4.	趙偉, 鄭哲. 50 至 70 歲心臟瓣膜置換患者瓣膜選擇與長期預后. 中國心血管病研究, 2020, 18(4): 330-333.
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6.	張海波, 孟旭, 王勝洵, 等. 經導管二尖瓣生物瓣毀損的瓣中瓣治療技術. 中華胸心血管外科雜志, 2019, 35(6): 331-333.
7.	Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
8.	Wenaweser P, Buellesfeld L, Gerckens U, et al. Percutaneous aortic valve replacement for severe aortic regurgitation in degenerated bioprosthesis: the first valve in valve procedure using the Corevalve Revalving System. Catheter Cardiovasc Interv, 2007, 70(5): 760-764.
9.	Cheung A, Webb JG, Wong DR, et al. Transapical transcatheter mitral valve-in-valve implantation in a human. Ann Thorac Surg, 2009, 87(3): e18-e20.
10.	Elmariah S, Arzamendi D, Llanos A, et al. First experience with transcatheter valve-in-valve implantation for a stenotic mitral prosthesis within the United States. JACC Cardiovasc Interv, 2012, 5(5): e13-e14.
11.	Tada N, Enta Y, Sakurai M, et al. Transcatheter valve-in-valve implantation for failed mitral prosthesis: the first experience in Japan. Cardiovasc Interv Ther, 2017, 32(1): 82-86.
12.	Shivaraju A, Michel J, Frangieh AH, et al. Transcatheter aortic and mitral valve-in-valve implantation using the Edwards Sapien 3 heart valve. J Am Heart Assoc, 2018, 7(14): e007767.
13.	Ye J. Transcatheter aortic valve replacement for isolated aortic regurgitation is coming!. J Thorac Cardiovasc Surg, 2018, 156(1): 117-118.
14.	Ye J, Lee AJ, Blanke P, et al. The first transapical transcatheter aortic valve-in-valve implantation using the J-valve system into a failed biophysio aortic prosthesis in a patient with high risk of coronary obstruction. Catheter Cardiovasc Interv, 2018, 92(6): 1209-1214.
15.	Ye J, Cheung A, Yamashita M, et al. Transcatheter aortic and mitral valve-in-valve implantation for failed surgical bioprosthetic valves: an 8-year single-center experience. JACC Cardiovasc Interv, 2015, 8(13): 1735-1744.
16.	Gaia DF, Braz AM, Simonato M, et al. Mitral implant of the inovare transcatheter heart valve in failed surgical bioprostheses: a novel alternative for valve-in-valve procedures. Interact Cardiovasc Thorac Surg, 2017, 24(4): 514-520.
17.	Urena M, Brochet E, Lecomte M, et al. Clinical and haemodynamic outcomes of balloon-expandable transcatheter mitral valve implantation: a 7-year experience. Eur Heart J, 2018, 39(28): 2679-2689.
18.	Takagi H, Hari Y, Kawai N, et al. A meta-analysis of valve-in-valve and valve-in-ring transcatheter mitral valve implantation. J Interv Cardiol, 2018, 31(6): 899-906.
19.	Yoon SH, Whisenant BK, Bleiziffer S, et al. Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification. Eur Heart J, 2019, 40(5): 441-451.
20.	胡盛壽, 高潤霖, 劉力生, 等. 《中國心血管病報告 2018》概要. 中國循環雜志, 2019, 34(3): 209-220.
21.	Bapat VV, Khaliel F, Ihleberg L. Delayed migration of Sapien valve following a transcatheter mitral valve-in-valve implantation. Catheter Cardiovasc Interv, 2014, 83(1): E150-E154.

1. 孟旭, 白濤. 5066 例瓣膜手術的圍術期臨床回顧. 中華胸心血管外科雜志, 2007, 23(1): 11-13.
2. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
3. Barbanti M, Costa G, Zappulla P, et al. Incidence of long-term structural valve dysfunction and bioprosthetic valve failure after transcatheter aortic valve replacement. J Am Heart Assoc, 2018, 7(15): e008440.
4. 趙偉, 鄭哲. 50 至 70 歲心臟瓣膜置換患者瓣膜選擇與長期預后. 中國心血管病研究, 2020, 18(4): 330-333.
5. Gao G, Wu Y, Grunkemeier GL, et al. Durability of pericardial versus porcine aortic valves. J Am Coll Cardiol, 2004, 44(2): 384-388.
6. 張海波, 孟旭, 王勝洵, 等. 經導管二尖瓣生物瓣毀損的瓣中瓣治療技術. 中華胸心血管外科雜志, 2019, 35(6): 331-333.
7. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
8. Wenaweser P, Buellesfeld L, Gerckens U, et al. Percutaneous aortic valve replacement for severe aortic regurgitation in degenerated bioprosthesis: the first valve in valve procedure using the Corevalve Revalving System. Catheter Cardiovasc Interv, 2007, 70(5): 760-764.
9. Cheung A, Webb JG, Wong DR, et al. Transapical transcatheter mitral valve-in-valve implantation in a human. Ann Thorac Surg, 2009, 87(3): e18-e20.
10. Elmariah S, Arzamendi D, Llanos A, et al. First experience with transcatheter valve-in-valve implantation for a stenotic mitral prosthesis within the United States. JACC Cardiovasc Interv, 2012, 5(5): e13-e14.
11. Tada N, Enta Y, Sakurai M, et al. Transcatheter valve-in-valve implantation for failed mitral prosthesis: the first experience in Japan. Cardiovasc Interv Ther, 2017, 32(1): 82-86.
12. Shivaraju A, Michel J, Frangieh AH, et al. Transcatheter aortic and mitral valve-in-valve implantation using the Edwards Sapien 3 heart valve. J Am Heart Assoc, 2018, 7(14): e007767.
13. Ye J. Transcatheter aortic valve replacement for isolated aortic regurgitation is coming!. J Thorac Cardiovasc Surg, 2018, 156(1): 117-118.
14. Ye J, Lee AJ, Blanke P, et al. The first transapical transcatheter aortic valve-in-valve implantation using the J-valve system into a failed biophysio aortic prosthesis in a patient with high risk of coronary obstruction. Catheter Cardiovasc Interv, 2018, 92(6): 1209-1214.
15. Ye J, Cheung A, Yamashita M, et al. Transcatheter aortic and mitral valve-in-valve implantation for failed surgical bioprosthetic valves: an 8-year single-center experience. JACC Cardiovasc Interv, 2015, 8(13): 1735-1744.
16. Gaia DF, Braz AM, Simonato M, et al. Mitral implant of the inovare transcatheter heart valve in failed surgical bioprostheses: a novel alternative for valve-in-valve procedures. Interact Cardiovasc Thorac Surg, 2017, 24(4): 514-520.
17. Urena M, Brochet E, Lecomte M, et al. Clinical and haemodynamic outcomes of balloon-expandable transcatheter mitral valve implantation: a 7-year experience. Eur Heart J, 2018, 39(28): 2679-2689.
18. Takagi H, Hari Y, Kawai N, et al. A meta-analysis of valve-in-valve and valve-in-ring transcatheter mitral valve implantation. J Interv Cardiol, 2018, 31(6): 899-906.
19. Yoon SH, Whisenant BK, Bleiziffer S, et al. Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification. Eur Heart J, 2019, 40(5): 441-451.
20. 胡盛壽, 高潤霖, 劉力生, 等. 《中國心血管病報告 2018》概要. 中國循環雜志, 2019, 34(3): 209-220.
21. Bapat VV, Khaliel F, Ihleberg L. Delayed migration of Sapien valve following a transcatheter mitral valve-in-valve implantation. Catheter Cardiovasc Interv, 2014, 83(1): E150-E154.

West China Medical Journal

Transcatheter valve-in-valve implantation treatment for mitral bioprosthesis deterioration: short-term follow-up

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