Journal Article

149-ITRANSCATHETER VALVE IMPLANTATION FOR NATIVE MITRAL VALVE DISEASE: ANOTHER MILESTONE BY THE HEART TEAM

I. Manoly, S. McAnelly, V. Mahadevan, B. Clarke and R. Hasan

in Interactive CardioVascular and Thoracic Surgery

Published on behalf of European Association for Cardio-Thoracic Surgery

Volume 17, issue suppl_2, pages S105-S105
Published in print October 2013 | ISSN: 1569-9293
Published online October 2013 | e-ISSN: 1569-9285 | DOI: http://dx.doi.org/10.1093/icvts/ivt372.149
149-ITRANSCATHETER VALVE IMPLANTATION FOR NATIVE MITRAL VALVE DISEASE: ANOTHER MILESTONE BY THE HEART TEAM

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Objectives: Open cardiac surgery has previously been considered the only definitive treatment for symptomatic valvular disease, with high-risk surgical patients presenting a challenge. The last decade witnessed the concept of the heart team with the integration of cardiologists and surgeons. This case is the first to demonstrate the successful implantation of a transcatheter bioprosthetic valve in the mitral position for the native valve through a transapical approach.

Methods: A 70-year-old lady presented with severe pulmonary oedema due to severe mitral stenosis. She had previously undergone a mechanical aortic valve replacement, coronary artery bypass grafts, an endarterectomy for calcification of the ascending aorta and a lower lobe lobectomy. During her stay, she went into type II respiratory failure and was intubated and admitted to the Intensive Care Unit (ICU). A transoesophageal echo revealed severe mitral stenosis and coexisting moderate mitral regurgitation with a valve area measuring 0.9 cm2 and with a mean gradient of 7 mmHg. Her calculated EuroSCORE II was 34.9%. At a multidisciplinary team meeting it was agreed that conventional surgery or balloon valvuloplasty would be too high-risk, quoting an operative risk of 50%. With the approval of her family, permission was requested from the Medicines and Healthcare Products Regulatory Agency to attempt to replace the valve using a transcatheter procedure.

Results: Under general anaesthesia, a 29 mm Edward Sapien XT transcatheter aortic bioprosthesis was successfully implanted through an anterior mini-thoracotomy over the apex. Post-procedure transoesophageal echocardiogram showed correct placement of the valve within the native valve with mild mitral regurgitation. She was haemodynamically stable and was transferred to the ICU where she stayed for the following 10 weeks due to left upper lobe collapse. Six months postoperatively, she is currently doing well.

Conclusions: This case illustrates the value of the multidisciplinary team approach to healthcare. By combining the knowledge and skills from different areas of medicine, outcomes that were once seen as unfeasible can be achieved, enhancing patient care and prognosis.

Journal Article.  0 words. 

Subjects: Cardiovascular Medicine ; Cardiothoracic Surgery

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