Thorac Cardiovasc Surg 2011; 59 - eP8
DOI: 10.1055/s-0030-1268939

Transcatheter aortic valve implantation after previous mechanical mitral valve replacement: Expanding indications?

CJ Beller 1, R Bekeredjian 2, U Krumsdorf 2, R Leipold 3, HA Katus 2, M Karck 1, W Rottbauer 2, K Kallenbach 1
  • 1Heart Centre Heidelberg, Clinic for Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
  • 2Heart Centre Heidelberg, Internal Medicine, Department for Cardiology, Angiology and Pulmonology, University of Heidelberg, Heidelberg, Germany
  • 3Department of Anaesthesiology, University of Heidelberg, Heidelberg, Germany

Objektives: Cardiac Operation for severe aortic stenosis in old and multimorbid patients after previous mitral valve replacement is a surgical challenge. Transcatheter aortic valve implantation (TAVI) after previous mechanical mitral valve replacement is so far considered as high-risk procedure due to possible interference with the mitral valve prosthesis.

Methods: Since August 2008, five female high-risk patients with severe aortic stenosis and previous mitral valve replacement (mean age: 80±5.1; logistic EuroScore: 39.3±20.5%) underwent TAVI using a pericardial xenograft valve fixed with a stainless, balloon-expandable stent (Edwards SAPIEN). Transapical approach was used in four patients, transfemoral approach in one patient. In addition to TEE, multi-detector computer tomography was used for preoperative planning and assessment of feasibility. Distance between aortic annulus and mitral valve prosthesis was 10±1 (9–11)mm in all cases.

Results: TAVI was performed sucessfully in all 5 patients. There were no direct or functional interferences with the mechanical mitral valve prostheses. Echocardiography revealed good valve function with not more than mild paravalvular incompetence early postoperatively and during routine follow-up. There were no neurological events. However, two patients died after initial uneventful course due to fulminant pneumonia at POD 4 and 48, with good aortic valve function at the most recent echo.

Conclusions: TAVI in high-risk patients after previous mechanical mitral valve replacement is technically feasible. However, careful patient selection with respect to preoperative clinical status and anatomic dimensions regarding the distance between aortic annulus and mitral valve prosthesis is mandatory.