Trans-femoral Trans-septal Mitral Valve Replacement using the Evoque Device in Patient with Severe Degenerative Mitral Regurgitation

History: An 88 year old male referred to the heart team with NYHA class III symptomatic severe degenerative mitral regurgitation (MR). Other comorbidities included non-ischemic cardiomyopathy with preserved ejection-fraction, coronary artery disease with recent stenting, atrial-fibrillation and pacemaker in situ. STS risk 3.8%.

Preoperative assessment: Transthoracic echocardiography showed normal systolic function and severe eccentric MR with myxomatous large anterior and small posterior mitral leaflets. Heart team determined the patient to be non-operable. CT and echo demonstrated suitability for 48 mm Evoque with low risk for LVOT obstruction.

Procedure: Utilizing percutaneous femoral venous access, a transseptal deflectable sheath was placed in the left atrium. A steerable catheter was advanced and a 48 mm Evoque was delivered under fluoroscopy and TEE guidance.

Outcome: Total MR was reduced to trivial and mean mitral gradient by TEE was 3.2 ± 1.4 mm Hg. Iatrogenic atrial septal defect closure was performed. The patient was discharged on day 2 to continue on medical management. No other procedural complications occurred.

Conclusion: Percutaneous transseptal transcatheter mitral valve replacement is feasible in patients with MR who are at high risk for surgery.