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

Figure 2

Transcatheter mitral valve in a degenerated Mosaic® ultra™ (Medtronic) valve (TMViV) with a concomitant transcatheter aortic valve implantation (TAVI). A 51-year-old male patient had a degenerated 23-mm Mosaic® ULTRA™ bioprosthetic MV (Medtronic) and a degenerated calcific AV with an associated AF. (a) TTE, TEE, and 3D-TEE show a degenerated bioprosthetic MV (severe MS and severe MR) and a calcific degenerated AV (severe AS and severe AR). (b) Fluoroscopy shows a transaortic TAVI of an Edward SAPIEN-3 26 mm valve during rapid pacing. (c) Fluoroscopy shows pre-TMViV balloon dilatation using a CRISTAL, BALT balloon 22 mm over a 0.035-inch/260 extra-stiff Confida™ guidewire. Then, transseptal TMViV of an Edwards SAPIEN-3 23 mm valve with post-TMViV distal valve flaring, followed by transseptal implantation of a wireless pacemaker as the patient developed CHB. (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, CHB: complete heart block, 3D: three-dimensional, 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, TEE: transesophageal echocardiography, and TTE: transthoracic echocardiography.

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