Pitfalls in TAMVI: experience with the repositionable Lotus® Valve System.

Heinisch, Paul P; Praz, Fabien; Winkler, Bernhard; Windecker, Stephan; Huber, Christoph; Carrel, Thierry (2017). Pitfalls in TAMVI: experience with the repositionable Lotus® Valve System. Journal of cardiothoracic surgery, 12(1), p. 47. Biomed Central 10.1186/s13019-017-0615-3

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BACKGROUND Simultaneous transapical implantation of transcatheter heart valves in the native mitral and aortic position may be considered as an alternative to surgical valve replacement in high-risk patients presenting with combined valve disease. CASE PRESENTATION A 59-year-old female with severe aortic stenosis, severe mitral stenosis with mild mitral insufficiency, persistent atrial fibrillation, severe chronic obstructive pulmonary disease and NYHA class of IV was evaluated by our interdisciplinary heart team. Due to the calculated Euroscore II, logistic Euroscore with 10% and 17% a decision was made towards a transapical TAVI approach. The implantation of a Sapien 3 (Edwards Lifesciences) valve in the aortic position was performed and the perioperative TEE showed a good result. The preoperative imaging revealed a narrow LVOT with risk for post interventional left ventricular outflow tract obstruction. Accordingly, it was decided against the use of balloon-expanding valves for the mitral valve position in the interdisciplinary team, as it is not repositionable. Instead, it was decided for the use of a Lotus (Boston Scientific) valve, as it is repositionable and therefore possible to retract in case of LVOT obstruction. In the present case of double valve intervention, the implantation attempt of a fully repositionable transcatheter heart valve into the native mitral annulus resulted in acute LVOT obstruction requiring immediate removal of the device. The patient was extubated and experienced uneventful postoperative recovery. CONCLUSIONS The case shows that improved preoperative work-up is necessary for better prediction of significant LVOT obstruction following transcatheter mitral valve implantation. In borderline cases, the use of a fully repositionable device is preferred.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Praz, Fabien; Winkler, Bernhard; Windecker, Stephan and Carrel, Thierry

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1749-8090

Publisher:

Biomed Central

Language:

English

Submitter:

Daniela Huber

Date Deposited:

21 Sep 2017 16:27

Last Modified:

24 Sep 2017 02:15

Publisher DOI:

10.1186/s13019-017-0615-3

PubMed ID:

28606165

Uncontrolled Keywords:

Case report Left ventricular outflow tract obstruction TA-MVI TAVI Transcatheter intervention

BORIS DOI:

10.7892/boris.101628

URI:

https://boris.unibe.ch/id/eprint/101628

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