Transcatheter Aortic Valve Implantation in Patients with Mechanical Mitral Valves - A Single Center Experience

Background: Transcatheter aortic valve implantation (TAVI) in patients with mechanical mitral valves (MMV) may carry increased risk of bleeding, MMV malfunction and endocarditis. Post-procedural MMV malfunction may result from valve thrombosis or from interaction between the prosthetic mitral and aortic valves. We report our experience with patients with MMV undergoing TAVI.

Methods: Our prospective institutional TAVI registry was retrospectively analyzed to identify patients with prior MMV. Clinical characteristics and procedural outcomes were documented.

Results: Between 1/2010 and 12/2018, 539 TAVI procedures were performed at our center. Six of these patients had undergone prior mitral valve replacement with a mechanical prosthesis. One patient had a caged ball (Star-Edwards) MMV and all others had single or bi-leaflet prosthetic mitral valves. Mean age was 69±3 years, mean left ventricular ejection fraction was 57±6%, all patients had permanent atrial fibrillation and 50% were females. Mean STS score was 2.6±1.4 and Euroscore-II was 6.3±4. All patients were on warfarin treatment and required peri-procedural bridging with Enoxaparin. Warfarin treatment was resumed once vascular access site hemostasis was confirmed. On pre-procedural cardiac computed tomographic angiography, the distance between the aortic valve annulus and the MMV was 5.0±2.2 mm (range: 3.0-8.0 mm). A Corevalve was implanted in 1 patient, Evolut R in 2 patients and Sapien-S3 valves in 3 patients. VARC-2 defined procedural success was achieved in all patients. No mechanical valve malfunction occurred. One patient sustained major bleeding (a large retro-peritoneal hematoma) which was treated conservatively, and the patient recovered completely. No deaths or endocarditis were documented at 30-days and at one-year follow-up.

Conclusion: In our experience, TAVI in patients with prior MMV is feasible, and associated with good outcomes.