Valve-in-valve transcatheter mitral valve replacement with SAPIEN 3 valve for bioprosthetic mitral valve failure: one-year outcomes in 26 patients.
10.3724/zdxbyxb-2024-0454
- Author:
Zechao RAN
1
;
Lulu LIU
2
;
Jun SHI
3
;
Yuqiang WANG
3
;
Tingqian CAO
4
;
Siyu HE
3
;
Xiaoting LI
3
;
Yingqiang GUO
5
Author Information
1. Department of Cardiovascular Surgery, Institute of Cardiovascular Surgery, West China Hospital,Sichuan University, Chengdu 610045, China. ranzechao@stu.scu.edu.cn.
2. Department of Cardiovascular Surgery, Institute of Cardiovascular Surgery, West China Hospital,Sichuan University, Chengdu 610045, China. 474036265@qq.com.
3. Department of Cardiovascular Surgery, Institute of Cardiovascular Surgery, West China Hospital,Sichuan University, Chengdu 610045, China.
4. Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu 610041, China.
5. Department of Cardiovascular Surgery, Institute of Cardiovascular Surgery, West China Hospital,Sichuan University, Chengdu 610045, China. drguoyq@wchscu.cn.
- Publication Type:Journal Article
- Keywords:
Bioprosthetic valve failure;
Mitral valve;
Retrospective study;
Transcatheter mitral valve replacement;
Valve-in-valve prosthetic valve implantation
- MeSH:
Humans;
Female;
Male;
Retrospective Studies;
Aged;
Bioprosthesis;
Heart Valve Prosthesis;
Mitral Valve/surgery*;
Heart Valve Prosthesis Implantation/methods*;
Middle Aged;
Prosthesis Failure;
Treatment Outcome;
Mitral Valve Insufficiency/surgery*
- From:
Journal of Zhejiang University. Medical sciences
2025;54(5):668-675
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVES:To evaluate the one-year outcomes of valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) using SAPIEN 3 valve for treating mitral bioprosthetic valve failure.
METHODS:A retrospective analysis was conducted on 26 patients with mitral bioprosthetic valve failure who underwent ViV-TMVR at West China Hospital, Sichuan University, between November 2022 and July 2024. The age of patients was 71.5 (64.5, 74.5) years, and 69.2% were female. Bioprosthetic valve failure occurred at (9.7±3.7) years after initial surgical implantation, with the most common failure mode being mixed stenosis and regurgitation (53.8%). The SAPIEN 3 valve was implanted via either a transseptal or transapical approach. Echocardiography was performed preoperatively, immediately post-procedure, and at 1 month, 6 months, and 1 year post-procedure. Outcomes included all-cause mortality, New York Heart Association (NYHA) functional class, Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 score, and postoperative complications.
RESULTS:The procedure was performed via the transseptal approach in 21 patients (80.8%) and the transapical approach in 5 patients (19.2%). All procedures were technically successful. No paravalvular leakage was observed immediately post-procedure, and mitral valve hemodynamics improved significantly. At the 1-year follow-up, 2 patients had died. Two patients (8.3% of survivors) were of NYHA functional class Ⅲ, and KCCQ-12 score improved to (88.4±14.6) points (both P<0.01). Echocardio-graphy at 1 year postoperatively showed significant reductions in peak mitral valve velocity [to (2.29±0.32) m/s] and mean transvalvular pressure gradient [to (9.5±3.5) mmHg, 1 mmHg=0.133 kPa] compared to baseline (both P<0.05). No moderate or severe mitral regurgitation or paravalvular leakage was observed. The proportion of patients with moderate-to-severe pulmonary hypertension decreased from 65.4% preoperatively to 13.0% at 1 year (P<0.05).
CONCLUSIONS:ViV-TMVR with the SAPIEN 3 valve for mitral biopro-sthetic valve failure is associated with high procedural success, significantly improved valve hemodynamics of the mitral value, alleviation of pulmonary hypertension, enhanced quality of life, and a low rate of complications at 1 year after the operation.
