TAVI in Patients who Underwent Mitral Valve Interventions

Background:
Transcatheter aortic valve implentation (TAVI) was shown to be a safe procedure for high risk symptomatic aortic stenosis patients. Nevertheless, due to the proximity of the mitral and aortic valve, the presence of a mitral ring or prosthetic valve may influence TAVI results. There is very limited data concerning the use of TAVI in patients who underwent mitral valve intervention.

Methods:
A retrospective report on 12 high risk symptomatic aortic stenosis or regurgitation patients who had a previous mitral valve repair or replacement, who underwent TAVI in Sheba medical center in Israel between 2011-2016.

Results:
12 patient (9 women, 75%), mean age of 76±6 years, underwent TAVI post mitral valve intervention. 1 had a biologic mitral valve, 8 had a mechanical mitral valve, and 3 were post mitral valve repair. the mean Euroscore2 and STS scores was 11.5% and 5.9%, respectively. 9 patients had severe aortic stenosis and 3 had severe aortic regurgitation. 8 patients received a self-expandable valve, and 4 received a balloon expandable valve. During the procedure 3 patients (25%) underwent balloon post dilatation, one patient (8%) required a transplantation of a second valve and one patient underwent a valve snaring, due to impingement on the mitral valve. Post procedure complications included 3 (25%) major bleeds; 3 (25%) acute kidney injuries. There were no acute MI, stroke or a need for dialysis. 11 (91.6%) of the patients were discharged from hospitalization. 1 patient (8.4%) with an STS score of 14.2 suffered a major vascular complication: an anterior wall perforation and tamponade during an urgent valve-in-valve implantation, and died during post-hospital rehabilitation.

Conclusion:
TAVI in the presence of mitral valve prosthesis is a challenging procedure. There is a need for meticulous pre-procedural anatomic assessment in order to select the appropriate patients and transcatheter valve.