New Percutaneous Approaches for the Treatment of Heavily Calcified Mitral Valve Stenosis
Abstract
:1. Introduction
2. Traditional Percutaneous Approach for Mitral Stenosis
3. Lithotripsy-Facilitated Percutaneous Mitral
3.1. Commissurotomy
3.2. Valve in Mitral Annular Calcifications (“Valve-in-MAC”)
- (a)
- Paravalvular leakage (PVL) since the mitral annulus is not circular but D-shaped. This complication can be avoided by prosthesis over-sizing;
- (b)
- Bioprosthesis embolization, in cases of non-complete circumferential MAC;
- (c)
- Obstruction of the LV outflow tract (LVOT) due to displacement of the anterior leaflet of the mitral valve. This event carries higher mortality rates, is more frequent in ViMAC than in ViV or ViR, can be anticipated with precise imaging-based preprocedural planning (CT), and may be solved with midline lacerations of the anterior leaflet (laceration of the anterior mitral leaflet to prevent Outflow obstruction during TMVR: LAMPOON technique) [14] or by means of alcohol septal ablation (ASA) if coronary anatomy is suitable [15];
- (d)
- Similar surgical treatments, valvular mismatch, or the impossibility to implant any available prosthesis in very large mitral annuli.
4. Future Directions
- (a)
- In MITRAL II (NCT04408430), a prospective non-randomized multicenter trial, 110 patients will be treated with ViMAC (SAPIEN 3 and SAPIEN 3 Ultra), and 100 patients not suitable for ViMAC will be treated with optimal medical treatment and will serve as controls.
- (b)
- In SITRAL (NCT02830204), 30 patients at a high risk for mitral valve surgery or deemed inoperable due to the extent of calcification will be treated with surgical SAPIEN 3 valve implantation.
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Study | n | Design | Type of Valve | Transseptal Approach * | Technical Success ** | Outcome | Follow-up | Results |
---|---|---|---|---|---|---|---|---|
Eleid 2017 [17] | 12 (ViMAC arm) | Retrospective multicenter registry | Edwards SAPIEN (100%) | 97% | 75% | Death or cardiac surgery | 30 days−1 year | 22−32% |
Guerrero 2018 [18] | 106 | Retrospective multicenter registry | Edwards SAPIEN (98%), Inovare (2%) | 41% | 77% | All-cause mortality | 3 months−1 year | 25−54% |
Yoon 2019 [19] | 58 (ViMAC arm) | Prospective multicenter registry | Edwards SAPIEN (81%), Lotus (16%), Direct Flow (3%) | 53% | 62% | All-cause mortality | 3 months−1 year | 35−63% |
Tiwana 2020 [20] | 28 (ViMAC arm) | Retrospective single-center registry | Edwards SAPIEN (100%) | 86% | 57% | All-cause mortality | 30 days | 21% |
Eng 2021 [21] | 19 (ViMAC arm) | Prospective single-center registry | Edwards SAPIEN (100%) | 95% | 63% | All-cause mortality | 1 year | 58% |
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Sanz-Ruiz, R.; Vázquez-Álvarez, M.E.; Gutiérrez-Ibañes, E.; Díez-delHoyo, F.; Tamargo-Delpon, M.; García-Carreño, J.; Soriano-Trigueros, J.; Elízaga-Corrales, J.; Fernández-Avilés, F. New Percutaneous Approaches for the Treatment of Heavily Calcified Mitral Valve Stenosis. J. Clin. Med. 2022, 11, 6444. https://doi.org/10.3390/jcm11216444
Sanz-Ruiz R, Vázquez-Álvarez ME, Gutiérrez-Ibañes E, Díez-delHoyo F, Tamargo-Delpon M, García-Carreño J, Soriano-Trigueros J, Elízaga-Corrales J, Fernández-Avilés F. New Percutaneous Approaches for the Treatment of Heavily Calcified Mitral Valve Stenosis. Journal of Clinical Medicine. 2022; 11(21):6444. https://doi.org/10.3390/jcm11216444
Chicago/Turabian StyleSanz-Ruiz, Ricardo, María Eugenia Vázquez-Álvarez, Enrique Gutiérrez-Ibañes, Felipe Díez-delHoyo, María Tamargo-Delpon, Jorge García-Carreño, Javier Soriano-Trigueros, Jaime Elízaga-Corrales, and Francisco Fernández-Avilés. 2022. "New Percutaneous Approaches for the Treatment of Heavily Calcified Mitral Valve Stenosis" Journal of Clinical Medicine 11, no. 21: 6444. https://doi.org/10.3390/jcm11216444
APA StyleSanz-Ruiz, R., Vázquez-Álvarez, M. E., Gutiérrez-Ibañes, E., Díez-delHoyo, F., Tamargo-Delpon, M., García-Carreño, J., Soriano-Trigueros, J., Elízaga-Corrales, J., & Fernández-Avilés, F. (2022). New Percutaneous Approaches for the Treatment of Heavily Calcified Mitral Valve Stenosis. Journal of Clinical Medicine, 11(21), 6444. https://doi.org/10.3390/jcm11216444