TY - JOUR
T1 - Previously implanted mitral surgical prosthesis in patients undergoing transcatheter aortic valve implantation: Procedural outcome and morphologic assessment using multidetector computed tomography
AU - Tanaka, Makoto
AU - Yanagisawa, Ryo
AU - Yashima, Fumiaki
AU - Arai, Takahide
AU - Jinzaki, Masahiro
AU - Shimizu, Hideyuki
AU - Fukuda, Keiichi
AU - Watanabe, Yusuke
AU - Naganuma, Toru
AU - Shirai, Shinichi
AU - Araki, Motoharu
AU - Tada, Norio
AU - Yamanaka, Futoshi
AU - Higashimori, Akihiro
AU - Takagi, Kensuke
AU - Ueno, Hiroshi
AU - Tabata, Minoru
AU - Mizutani, Kazuki
AU - Yamamoto, Masanori
AU - Hayashida, Kentaro
AU - OCEANTAVI investigators
AU - Hayashida, Kentaro
AU - Yamamoto, Masanori
AU - Shimura, Tetsuro
AU - Adachi, Yuya
AU - Yamaguchi, Ryo
AU - Sago, Mitsuru
AU - Tsunaki, Tatsuya
AU - Hosoba, Soh
AU - Koyama, Yutaka
AU - Kagase, Ai
AU - Tokuda, Takahiro
AU - Kobayashi, Toshihiro
AU - Shibata, Kenichi
AU - Watanabe, Yusuke
AU - Hioki, Hirofumi
AU - Kataoka, Akihisa
AU - Yamamoto, Hirosada
AU - Kawashima, Hideyuki
AU - Nakashima, Makoto
AU - Nara, Yugo
AU - Nagura, Fukuko
AU - Ito, Masaki
AU - Sasaki, Kazuya
AU - Ishibashi, Ruri
AU - Yukimitsu, Nozomu
AU - Takamura, Shintaro
AU - Nomura, Takahiro
AU - Naganuma, Toru
AU - Mitomo, Satoru
AU - Onishi, Hirokazu
PY - 2019/12/1
Y1 - 2019/12/1
N2 - 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.
AB - 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85077261503&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31877159
U2 - https://doi.org/10.1371/journal.pone.0226512
DO - https://doi.org/10.1371/journal.pone.0226512
M3 - Article
C2 - 31877159
SN - 1932-6203
VL - 14
JO - PLOS ONE
JF - PLOS ONE
IS - 12
M1 - e0226512
ER -