Mitral implant of the Inovare transcatheter heart valve in failed surgical bioprostheses: a novel alternative for valve-in-valve procedures

• Grant number: 17/09698-1
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: September 01, 2017
• End date: August 31, 2018
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Diego Felipe Gaia dos Santos
• Grantee: Raul Muffato Daolio
• Host Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil

Abstract

Reoperative procedure for the treatment of failed mitral bioprosthesis is associated with considerable risk. In some cases, mortality is high and might contraindicate the benefit of the procedure. The minimally invasive valve-in-valve transcatheter mitral valve implant offers an alternative less-invasive approach, reducing morbidity and mortality. The objective of this paper is to evaluate the mitral valve-in-valve approach using the Braile Inovare prosthesis. Methods: The transcatheter balloon-expandable Braile Inovare prosthesis was used in 12 cases. Procedures were performed in a hybrid operative room, under fluoroscopic and echocardiographic control. Through left minithoracotomy, the prostheses were implanted through the cardiac apex, under rapid pacing. Seriated echocardiographic and clinical controls were performed. Follow-up varied from 1 to 30 months. Results: A total of 12 transapical mitral valve-in-valve procedures were performed. Patients had a mean age of 61.6(±9.9) years and 92% were female. Mean Logistic EuroSCORE was 20.1%. Successful valve implantation was possible in all cases. In one case, a right lateral thoracotomy was performed for the removal of an embolized prosthesis. There was no operative mortality. 30-day mortality was 8.3%. Ejection fraction was preserved after the implant (66.7%; 64.8%; p = 0.3). The mitral gradient showed a significant reduction (11mmHg; 6mmHg; p < 0.001). Residual mitral regurgitation was not present. There was no left ventricular outflow tract obstruction. Conclusions: The mitral valve-in-valve transcatheter implant in failed bioprosthesis is an effective procedure. This possibility might alter prosthesis selection in the future initial surgical prosthesis selection, favoring bioprostheses. Further larger trials should explore its safety. (AU)