Pitfalls in TAMVI: experience with the repositionable Lotus® Valve System
Abstract Background Simultaneous transapical implantation of transcatheter heart valves in the native mitral and aortic position may be considered as an alternative to surgical valve replacement in high-risk patients presenting with combined valve disease. Case presentation A 59-year-old female with...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-06-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13019-017-0615-3 |
| _version_ | 1818515763943702528 |
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| author | Paul P. Heinisch Fabien Praz Bernhard Winkler Stephan Windecker Christoph Huber Thierry Carrel |
| author_facet | Paul P. Heinisch Fabien Praz Bernhard Winkler Stephan Windecker Christoph Huber Thierry Carrel |
| author_sort | Paul P. Heinisch |
| collection | DOAJ |
| description | Abstract Background Simultaneous transapical implantation of transcatheter heart valves in the native mitral and aortic position may be considered as an alternative to surgical valve replacement in high-risk patients presenting with combined valve disease. Case presentation A 59-year-old female with severe aortic stenosis, severe mitral stenosis with mild mitral insufficiency, persistent atrial fibrillation, severe chronic obstructive pulmonary disease and NYHA class of IV was evaluated by our interdisciplinary heart team. Due to the calculated Euroscore II, logistic Euroscore with 10% and 17% a decision was made towards a transapical TAVI approach. The implantation of a Sapien 3 (Edwards Lifesciences) valve in the aortic position was performed and the perioperative TEE showed a good result. The preoperative imaging revealed a narrow LVOT with risk for post interventional left ventricular outflow tract obstruction. Accordingly, it was decided against the use of balloon-expanding valves for the mitral valve position in the interdisciplinary team, as it is not repositionable. Instead, it was decided for the use of a Lotus (Boston Scientific) valve, as it is repositionable and therefore possible to retract in case of LVOT obstruction. In the present case of double valve intervention, the implantation attempt of a fully repositionable transcatheter heart valve into the native mitral annulus resulted in acute LVOT obstruction requiring immediate removal of the device. The patient was extubated and experienced uneventful postoperative recovery. Conclusions The case shows that improved preoperative work-up is necessary for better prediction of significant LVOT obstruction following transcatheter mitral valve implantation. In borderline cases, the use of a fully repositionable device is preferred. |
| first_indexed | 2024-12-11T00:33:08Z |
| format | Article |
| id | doaj.art-3ea54ad5d4954c649c062193e44d6117 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-12-11T00:33:08Z |
| publishDate | 2017-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-3ea54ad5d4954c649c062193e44d61172022-12-22T01:27:15ZengBMCJournal of Cardiothoracic Surgery1749-80902017-06-011211510.1186/s13019-017-0615-3Pitfalls in TAMVI: experience with the repositionable Lotus® Valve SystemPaul P. Heinisch0Fabien Praz1Bernhard Winkler2Stephan Windecker3Christoph Huber4Thierry Carrel5Department of Cardiovascular Surgery, Inselspital, University of BernDepartment of Cardiology, Inselspital, University of BernDepartment of Cardiovascular Surgery, Inselspital, University of BernDepartment of Cardiology, Inselspital, University of BernDepartment of Cardiovascular Surgery, Inselspital, University of BernDepartment of Cardiovascular Surgery, Inselspital, University of BernAbstract Background Simultaneous transapical implantation of transcatheter heart valves in the native mitral and aortic position may be considered as an alternative to surgical valve replacement in high-risk patients presenting with combined valve disease. Case presentation A 59-year-old female with severe aortic stenosis, severe mitral stenosis with mild mitral insufficiency, persistent atrial fibrillation, severe chronic obstructive pulmonary disease and NYHA class of IV was evaluated by our interdisciplinary heart team. Due to the calculated Euroscore II, logistic Euroscore with 10% and 17% a decision was made towards a transapical TAVI approach. The implantation of a Sapien 3 (Edwards Lifesciences) valve in the aortic position was performed and the perioperative TEE showed a good result. The preoperative imaging revealed a narrow LVOT with risk for post interventional left ventricular outflow tract obstruction. Accordingly, it was decided against the use of balloon-expanding valves for the mitral valve position in the interdisciplinary team, as it is not repositionable. Instead, it was decided for the use of a Lotus (Boston Scientific) valve, as it is repositionable and therefore possible to retract in case of LVOT obstruction. In the present case of double valve intervention, the implantation attempt of a fully repositionable transcatheter heart valve into the native mitral annulus resulted in acute LVOT obstruction requiring immediate removal of the device. The patient was extubated and experienced uneventful postoperative recovery. Conclusions The case shows that improved preoperative work-up is necessary for better prediction of significant LVOT obstruction following transcatheter mitral valve implantation. In borderline cases, the use of a fully repositionable device is preferred.http://link.springer.com/article/10.1186/s13019-017-0615-3Transcatheter interventionLeft ventricular outflow tract obstructionTAVITA-MVICase report |
| spellingShingle | Paul P. Heinisch Fabien Praz Bernhard Winkler Stephan Windecker Christoph Huber Thierry Carrel Pitfalls in TAMVI: experience with the repositionable Lotus® Valve System Journal of Cardiothoracic Surgery Transcatheter intervention Left ventricular outflow tract obstruction TAVI TA-MVI Case report |
| title | Pitfalls in TAMVI: experience with the repositionable Lotus® Valve System |
| title_full | Pitfalls in TAMVI: experience with the repositionable Lotus® Valve System |
| title_fullStr | Pitfalls in TAMVI: experience with the repositionable Lotus® Valve System |
| title_full_unstemmed | Pitfalls in TAMVI: experience with the repositionable Lotus® Valve System |
| title_short | Pitfalls in TAMVI: experience with the repositionable Lotus® Valve System |
| title_sort | pitfalls in tamvi experience with the repositionable lotus r valve system |
| topic | Transcatheter intervention Left ventricular outflow tract obstruction TAVI TA-MVI Case report |
| url | http://link.springer.com/article/10.1186/s13019-017-0615-3 |
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