Previously implanted mitral surgical prosthesis in patients undergoing transcatheter aortic valve implantation: Procedural outcome and morphologic assessment using multidetector computed tomography


Autoři: Makoto Tanaka aff001;  Ryo Yanagisawa aff001;  Fumiaki Yashima aff001;  Takahide Arai aff001;  Masahiro Jinzaki aff002;  Hideyuki Shimizu aff003;  Keiichi Fukuda aff001;  Yusuke Watanabe aff004;  Toru Naganuma aff005;  Shinichi Shirai aff006;  Motoharu Araki aff007;  Norio Tada aff008;  Futoshi Yamanaka aff009;  Akihiro Higashimori aff010;  Kensuke Takagi aff011;  Hiroshi Ueno aff012;  Minoru Tabata aff013;  Kazuki Mizutani aff014;  Masanori Yamamoto aff015;  Kentaro Hayashida aff001
Působiště autorů: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan aff001;  Department of Radiology, Keio University School of Medicine, Tokyo, Japan aff002;  Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan aff003;  Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan aff004;  Department of Cardiology, New Tokyo Hospital, Matsudo, Japan aff005;  Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan aff006;  Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan aff007;  Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan aff008;  Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan aff009;  Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan aff010;  Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan aff011;  Second Department of Internal Medicine, University of Toyama, Toyama, Japan aff012;  Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan aff013;  Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan aff014;  Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan aff015
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226512

Souhrn

Transcatheter aortic valve implantation (TAVI) in the presence of a preexisting mitral prosthesis is challenging and its influence on the morphology of mitral prosthesis and the positioning of transcatheter heart valve (THV) is unknown. We assessed the feasibility of TAVI for patients with preexisting mitral prostheses, its influence on mitral prosthesis morphology, and the positional interaction between a newly implanted THV and mitral prosthesis using serial multidetector computed tomography (MDCT). Thirty-one patients with preexisting mitral prosthesis undergoing TAVI were included. MDCT was performed before and after TAVI. Thirty patients successfully underwent TAVI without interference from preexisting mitral prosthesis. Although opening disturbance of the mechanical mitral prosthesis by the THV edge was observed in 1 patient, the patient was managed conservatively. No THV embolization occurred. THV shift during deployment occurred in 9 patients and was predicted by a larger aortic annulus area (odds ratio: 1.24 per 10 mm2, 1.03–1.49, p = 0.02), possibly because of large THVs. The mitral mean pressure gradient was slightly higher after TAVI (3.7 vs. 4.3 mmHg, p = 0.002), whereas the mitral regurgitation grade was similar. MDCT showed that the size of the mitral prosthesis housing was unchanged after TAVI. The median distance between the mitral prosthesis and THV was 2.6 mm. The postprocedural angle between the mitral prosthesis and THV was larger than the preprocedural angle between the mitral prosthesis and the left ventricular outflow tract (64° vs. 61°, p = 0.03). Thus, TAVI is feasible in the case of preexisting mitral prosthesis. Serial MDCT demonstrated favorable THV positioning and unchanged mitral prosthesis morphology after TAVI.

Klíčová slova:

Aortic valve – Blood pressure – Computed axial tomography – Medical implants – Prosthetics – Surgical and invasive medical procedures – Systolic pressure


Zdroje

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