Transcatheter Mitral Valve Implantation in Degenerated Bioprosthetic Valves


      • The importance of the Heart Team for transcatheter mitral valve in valve procedures.
      • The importance of 3D echocardiography for transcatheter procedures.
      • The importance of CT imaging transcatheter mitral valve in valve procedures.
      The use of bioprosthetic valves for mitral valve disease has been increasingly popular with both patients and physicians, and current practice uses these valves for increasingly younger patients. However, these valves are known to degenerate over time. Historically, reoperation was the only recourse for a failing bioprosthetic valve. Today, however, percutaneous options exist with the use of transcatheter valve implantation. Determining candidacy for this less invasive option requires careful evaluation with echocardiography. This review is focused on the echocardiographic evaluation required pre-, intra-, and postprocedurally during transcatheter mitral valve insertion.



      2D (Two-dimensional), 3D (Three-dimensional), CT (Computed tomographic), EOA (Effective orifice area), LV (Left ventricular), LVOT (Left ventricular outflow tract), MV (Mitral valve), PLAX (Parasternal long-axis), PSAX (Parasternal short-axis), SHV (Surgical heart valve), TEE (Transesophageal echocardiography), TMVR (Transcatheter mitral valve replacement)
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        • Holmes Jr., D.R.
        • Mack M.J.
        • Kaul S.
        • Agnihotri A.
        • Alexander K.P.
        • Bailey S.R.
        • et al.
        2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement: developed in collabration with the American Heart Association, American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Mended Hearts, Society of Cardiovascular Anesthesiologists, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance.
        J Thorac Cardiovasc Surg. 2012; 144: e29-e84
        • D’Agostino R.S.
        • Jacobs J.P.
        • Badhwar V.
        • Paone G.
        • Rankin J.S.
        • Han J.M.
        • et al.
        The Society of Thoracic Surgeons adult cardiac surgery database: 2017 update on outcomes and quality 20.
        Ann Thorac Surg. 2017; 103: 18-24
        • Bourguignon T.
        • Bouquiaux-Stablo A.L.
        • Loardi C.
        • Mirza A.
        • Candolfi P.
        • Marchand M.
        • et al.
        Very late outcomes for mitral valve replacement with the Carpentier-Edwards pericardial bioprosthesis: 25-year follow-up of 450 implantations.
        J Thorac Cardiovasc Surg. 2014; 148: 2004-2011.e1
        • Nishimura R.A.
        • Otto C.M.
        • Bonow R.O.
        • Carabello B.A.
        • Erwin J.P.
        • Fleisher L.A.
        • et al.
        2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines.
        Circulation. 2017; 135: E1159-E1195
        • Jones J.M.
        • O’Kane H.
        • Gladstone D.J.
        • Sarsam M.A.
        • Campalani G.
        • MacGowan S.W.
        • et al.
        Repeat heart valve surgery: risk factors for operative mortality.
        J Thorac Cardiovasc Surg. 2001; 122: 913-918
        • Losenno K.L.
        • Jones P.M.
        • Valdis M.
        • Fox S.A.
        • Kiaii B.
        • Chu M.W.A.
        Higher-risk mitral valve operations after previous sternotomy: endoscopic, minimally invasive approach improves patient outcomes.
        Can J Surg. 2016; 59: 399-406
        • Chikwe J.
        • Chiang Y.P.
        • Egorova N.N.
        • Itagaki S.
        • Adams D.H.
        Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years.
        JAMA. 2015; 313: 1435-1442
        • Goldstone A.B.
        • Chiu P.
        • Baiocchi M.
        • Lingala B.
        • Patrick W.L.
        • Fischbein M.P.
        • et al.
        Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement.
        N Engl J Med. 2017; 377: 1847-1857
        • Cheung A.
        • Webb J.G.
        • Wong D.R.
        • Ye J.
        • Masson J.B.
        • Carere R.G.
        • et al.
        Transapical transcatheter mitral valve-in-valve implantation in a human.
        Ann Thorac Surg. 2009; 87: E18-E20
        • Grover F.L.
        • Vemulapalli S.
        • Carroll J.D.
        • Edwards F.H.
        • Mack M.J.
        • Thourani V.H.
        • et al.
        2016 annual report of the Society of Thoracic Surgeons/American College of Cardiology transcatheter valve therapy registry.
        J Am Coll Cardiol. 2017; 69: 1215-1230
        • Webb J.G.
        • Wood D.A.
        • Ye J.
        • Gurvitch R.
        • Masson J.B.
        • Rodes-Cabau J.
        • et al.
        Transcatheter valve-in-valve implantation for failed bioprosthetic heart valves.
        Circulation. 2010; 121: 1848-1857
        • Ye J.
        • Cheung A.
        • Yamashita M.
        • Wood D.
        • Peng D.F.
        • Gao M.
        • et al.
        Transcatheter aortic and mitral valve-in-valve implantation for failed surgical bioprosthetic valves: an 8-year single-center experience.
        JACC Cardiovasc Interv. 2015; 8: 1735-1744
        • Wang D.D.
        • Eng M.H.
        • Greenbaum A.B.
        • Myers E.
        • Forbes M.
        • Karabon P.
        • et al.
        Validating a prediction modeling tool for left ventricular outflow tract (LVOT) obstruction after transcatheter mitral valve replacement (TMVR).
        Catheter Cardiovasc Interv. 2017; (In press)
        • Eleid M.F.
        • Cabalka A.K.
        • Williams M.R.
        • Whisenant B.K.
        • Alli O.O.
        • Fam N.
        • et al.
        Percutaneous transvenous transseptal transcatheter valve implantation in failed bioprosthetic mitral valves, ring annuloplasty, and severe mitral annular calcification.
        JACC Cardiovasc Interv. 2016; 9: 1161-1174
        • Frerker C.
        • Schmidt T.
        • Schluter M.
        • Bader R.
        • Schewel J.
        • Schewel D.
        • et al.
        Transcatheter implantation of aortic valve prostheses into degenerated mitral valve bioprostheses and failed annuloplasty rings: outcomes according to access route and Mitral Valve Academic Research Consortium (MVARC) criteria.
        Eurointervention. 2016; 12: 1520-1526
        • Petronio A.S.
        • Capranzano P.
        • Barbato E.
        • Piazza N.
        • Baumbach A.
        • Haude M.
        • et al.
        Current status of transcatheter mitral valve therapy in Europe: results from an EAPCI survey (part II).
        Eurointervention. 2017; 12: 1934-1939
        • Hudec V.
        • Bena M.
        • Artemiou P.
        • Gasparovic I.
        • Hulman M.
        Reversible thrombotic mitral valve stenosis after transcatheter mitral valve replacement (TMVR): is life-long anticoagulation therapy necessary?.
        J Card Surg. 2017; 32: 190-192
        • Zoghbi W.A.
        • Chambers J.B.
        • Dumesnil J.G.
        • Foster E.
        • Gottdiener J.S.
        • Grayburn P.A.
        • et al.
        Recommendations for evaluation of prosthetic valves with echocardiography and Doppler ultrasound: a report from the American Society of Echocardiography's guidelines and standards Committee and the task force on prosthetic valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography.
        J Am Soc Echocardiog. 2009; 22: 975-1014
        • Pibarot P.
        • Dumesnil J.G.
        Prosthetic heart valves: selection of the optimal prosthesis and long-term management.
        Circulation. 2009; 119: 1034-1048
        • Elkharbotly A.
        • Delago A.
        • El-Hajjar M.
        Simultaneous transapical transcatheter aortic valve replacement and transcatheter mitral valve replacement for native valvular stenosis.
        Catheter Cardiovasc Interv. 2016; 87: 1347-1351
        • Seiffert M.
        • Conradi L.
        • Baldus S.
        • Schirmer J.
        • Knap M.
        • Blankenberg S.
        • et al.
        Transcatheter mitral valve-in-valve implantation in patients with degenerated bioprostheses.
        JACC Cardiovasc Interv. 2012; 5: 341-349
        • Cheung A.
        • Webb J.G.
        • Barbanti M.
        • Freeman M.
        • Binder R.K.
        • Thompson C.
        • et al.
        5-Year experience with transcatheter transapical mitral valve-in-valve implantation for bioprosthetic valve dysfunction.
        J Am Coll Cardiol. 2013; 61: 1759-1766
        • Said S.M.
        • Pislaru S.
        • Kotkar K.D.
        • Rihal C.S.
        • Mauermann W.J.
        • Schaff H.V.
        • et al.
        Left ventricular outflow tract obstruction after transcatheter mitral valve-in-ring implantation: a word of caution.
        Ann Thorac Surg. 2016; 102: E495-E497
        • Bouleti C.
        • Fassa A.A.
        • Himbert D.
        • Brochet E.
        • Ducrocq G.
        • Nejjari M.
        • et al.
        Transfemoral implantation of transcatheter heart valves after deterioration of mitral bioprosthesis or previous ring annuloplasty.
        JACC Cardiovasc Interv. 2015; 8: 83-91
        • Blanke P.
        • Naoum C.
        • Dvir D.
        • Bapat V.
        • Ong K.
        • Muller D.
        • et al.
        Predicting LVOT obstruction in transcatheter mitral valve implantation: concept of the neo-LVOT.
        JACC Cardiovasc Imaging. 2017; 10: 482-485
        • Hamid N.B.
        • Khalique O.K.
        • Monaghan M.J.
        • Kodali S.K.
        • Dvir D.
        • Bapat V.N.
        • et al.
        Transcatheter valve implantation in failed surgically inserted bioprosthesis: review and practical guide to echocardiographic imaging in valve-in-valve procedures.
        JACC Cardiovasc Imaging. 2015; 8: 960-979
        • Kwon D.H.
        • Smedira N.G.
        • Popovic Z.B.
        • Lytle B.W.
        • Setser R.M.
        • Thamilarasan M.
        • et al.
        Steep left ventricle to aortic root angle and hypertrophic obstructive cardiomyopathy: study of a novel association using three-dimensional multimodality imaging.
        Heart. 2009; 95: 1784-1791
        • Egbe A.C.
        • Connolly H.M.
        • Pellikka P.A.
        • Schaff H.V.
        • Hanna R.
        • Maleszewski J.J.
        • et al.
        Outcomes of warfarin therapy for bioprosthetic valve thrombosis of surgically implanted valves: a prospective study.
        JACC Cardiovasc Interv. 2017; 10: 379-387
        • Egbe A.C.
        • Pislaru S.V.
        • Pellikka P.A.
        • Poterucha J.T.
        • Schaff H.V.
        • Maleszewski J.J.
        • et al.
        Bioprosthetic valve thrombosis versus structural failure clinical and echocardiographic predictors.
        J Am Coll Cardiol. 2015; 66: 2285-2294
        • Spoon D.B.
        • Malouf J.F.
        • Spoon J.N.
        • Nkomo V.T.
        • Sorajja P.
        • Mankad S.V.
        • et al.
        Mitral paravalvular leak description and assessment of a novel anatomical method of localization.
        JACC Cardiovasc Imag. 2013; 6: 1212-1214
        • Cavalcante J.L.
        • Rodriguez L.L.
        • Kapadia S.
        • Tuzcu E.M.
        • Stewart W.J.
        Role of echocardiography in percutaneous mitral valve interventions.
        JACC Cardiovasc Imaging. 2012; 5: 733-746
        • Blanke P.
        • Naoum C.
        • Webb J.
        • Dvir D.
        • Hahn R.T.
        • Grayburn P.
        • et al.
        Multimodality imaging in the context of transcatheter mitral valve replacement: establishing consensus among modalities and disciplines.
        JACC Cardiovasc Imaging. 2015; 8: 1191-1208
        • Thomas J.D.
        • Wilkins G.T.
        • Choong C.Y.
        • Abascal V.M.
        • Palacios I.F.
        • Block P.C.
        • et al.
        Inaccuracy of mitral pressure half-time immediately after percutaneous mitral valvotomy. Dependence on transmitral gradient and left atrial and ventricular compliance.
        Circulation. 1988; 78: 980-993
        • Maisano F.
        • Alfieri O.
        • Banai S.
        • Buchbinder M.
        • Colombo A.
        • Falk V.
        • et al.
        The future of transcatheter mitral valve interventions: competitive or complementary role of repair vs. replacement?.
        Eur Heart J. 2015; 36: 1651-1659
        • Khalique O.K.
        • Hahn R.T.
        Role of echocardiography in transcatheter valvular heart disease interventions.
        Curr Cardiol Rep. 2017; 19: 128