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Transfemoral transcatheter aortic valve replacement in the presence of a mitral prosthesis

Toutouzas, Konstantinosa; Drakopoulou, Mariaa; Latsios, Georgea; Synetos, Andreasa; Stathogiannis, Konstantinosa; Soulaidopoulos, Stergiosa; Oikonomou, Georgea; Trantalis, Georgea; Papanikolaou, Aggelosa; Aggeli, Constantinaa; Vavuranakis, Manolisa; Mastrokostopoulos, Antonisb; Katsimaglis, Georgeb; Voudris, Vassilisc; Dardas, Petrosd; Tousoulis, Dimitrisa

Journal of Cardiovascular Medicine: December 2019 - Volume 20 - Issue 12 - p 825–830
doi: 10.2459/JCM.0000000000000876
Research articles: Structural heart intervention
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Purpose In the current case series, we present our experience with the self-expanding CoreValve or Evolut R (Medtronic Inc.) in patients with severe symptomatic aortic valve stenosis and concomitant mitral valve prosthesis.

Methods Twelve patients with previous mitral valve prosthesis underwent transcatheter aortic valve replacement for severe symptomatic aortic valve stenosis and/or aortic valve regurgitation. All patients underwent evaluation with an echocardiogram, computed tomography and coronary angiogram. After the index intervention and before discharge all patients underwent transthoracic echocardiography. All outcomes were defined according to the Valve Academic Research Consortium-2 criteria.

Results Eleven patients underwent transcatheter aortic valve replacement for severe symptomatic aortic valve stenosis and one patient for severe aortic valve regurgitation. There was immediate improvement of patients’ hemodynamic status; no cases of procedural death, stroke, myocardial infarction, or urgent cardiac surgery occurred. There was no 30-day mortality and all patients improved, with 91.6% in functional New York Heart Association class I–II.

Conclusion The current study demonstrates that in patients with severe aortic valve stenosis or regurgitation and mitral valve prosthesis, the implantation of a self-expanding aortic valve via the transfemoral route is safe and feasible, with maintained long-term results.

aFirst Department of Cardiology, Medical School of Athens University, Hippokration Hospital

b2nd Cardiology Unit of Naval Hospital of Athens

c2nd Cardiology Division, Onassis Cardiac Surgery Center, Athens

dAgios Lukas Hospital, Thessaloniki, Greece

Correspondence to Konstantinos Toutouzas, MD, First Department of Cardiology, Medical School of Athens University, Hippokration Hospital, 26 Karaoli and Dimitriou Str., Holargos, 15562 Athens, Greece Tel: +30 210 6510860; fax: +30 210 7250153; e-mail: ktoutouz@gmail.com

Received 28 October, 2018

Revised 22 June, 2019

Accepted 7 July, 2019

© 2019 Italian Federation of Cardiology. All rights reserved.