Transcatheter Mitral Valve Replacement in High-Surgical Risk Patients: A Single-Center Experience and Outcome

Figure 1

Transcatheter mitral valve in a degenerated Carpentier–Edwards (Edwards Lifesciences) valve (TMViV) with a concomitant transcatheter aortic valve implantation (TAVI). A 64-year-old, diabetic, hypertensive female patient, with COPD and renal transplant, had a degenerated bioprosthetic 29 mm Carpentier–Edwards MV and a degenerated calcific AV with an associated AF. (a) TTE shows a degenerated bioprosthetic MV (severe MS and severe MR) with a calcific degenerated AV (severe AS and mild AR). (b) Fluoroscopy shows a transaortic TAVI of an Edwards SAPIEN-3 23 mm valve during rapid pacing. (c) Fluoroscopy shows an 8.5F-agilis™ sheath including a 5F-MP catheter over a 0.035-inch curved Terumo guidewire to cross the degenerated bioprosthetic MV to the LV, and then to the aorta. Balloon dilatation of the transseptal puncture using a 14 mm balloon over a 0.035-inch/260 extra-stiff Confida™ guidewire. Transseptal TMViV of an Edwards SAPIEN-3 29 mm valve. (d) TTE: both SAPIEN-3 valves are in mitral and aortic positions with normal flow across both valves. AF: atrial fibrillation, AR: aortic regurgitation, AS: aortic stenosis, AV: aortic valve, AVA: aortic valve area, COPD: chronic obstructive pulmonary disease, LV: left ventricle, MR: mitral regurgitation, MS: mitral stenosis, MV: mitral valve, MVA: mitral valve area, Pg: pressure gradient, TAVI: transcatheter aortic valve implantation, TMViV: transcatheter mitral valve-in-valve, and TTE: transthoracic echocardiography.

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