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

Figure 3

Transcatheter mitral valve in a degenerated EPIC™ (St. Jude Medical) valve (TMViV) with a concomitant transcatheter aortic valve implantation (TAVI). A 49-year-old old female patient with COPD had a degenerated bioprosthetic 29 mm EPIC™ MV and a degenerated bioprosthetic AV with an associated AF. TTE shows a degenerated bioprosthetic 29 mm EPIC™ MV (severe MS) and a degenerated bioprosthetic AV (severe AS). (b) Fluoroscopy shows the crossing of degenerated bioprosthetic AV with a 5F Amplatz left catheter over a 0.035-inch curved Terumo guidewire, followed by transaortic TAVI of an Edwards SAPIEN 3-26 mm valve during rapid pacing. Transseptal puncture using a 0-1 BRK™ within an 8.5F-SL sheath, followed by balloon dilatation of the transseptal puncture using a 12 mm balloon. (c) Fluoroscopy shows a transseptal TMViV of an Edwards SAPIEN-3 29-mm valve. First, an 8.5F-agilis™ sheath was flexed and directed towards the degenerated bioprosthetic MV. Second, a 5F-MP catheter over a 0.035-inch curved Terumo guidewire crossed the MV to the LV. Third, the wire was exchanged with a 0.035-inch/260 extra-stiff Confida™ guidewire. And finally, THV implantation. TTE: both SAPIEN-3 valves are in mitral and aortic positions with normal flow across both valves. AF: atrial fibrillation, AS: aortic stenosis, AV: aortic valve, COPD: chronic obstructive pulmonary disease, MS: mitral stenosis, MV: mitral valve, MVA: mitral valve area, Pg: pressure gradient, TAVI: transcatheter aortic valve implantation, TMViV: transcatheter mitral valve-in-valve, TTE: transthoracic echocardiography, and THV: transcatheter heart valve.

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