Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec;92(12):3298-3303.
doi: 10.1111/ans.18076. Epub 2022 Oct 6.

Transcatheter mitral valve-in-valve: treatment of rheumatic heart disease in young patients

Abbey Knox  1 , Jayme S Bennetts  1   2 , Damian Gimpel  1 , Richard F Newland  1   2 , Robert A Baker  1   2 , Majo X Joseph  3 , Gregory D Rice  1 , Nadarajah Kangaharan  4 , Ajay Sinhal  3
Affiliations

Transcatheter mitral valve-in-valve: treatment of rheumatic heart disease in young patients

Abbey Knox et al. ANZ J Surg. 2022 Dec.

Abstract

Background: Rheumatic heart disease (RHD) in young people presents a complex management problem. In Australia a significant proportion of those affected are Aboriginal and Torres Strait Islanders. Transcatheter mitral valve-in-valve (TMViV) replacement has emerged as an alternative to redo surgery in high-risk patients with degenerated mitral bioprostheses. The aim of this study is to review outcomes of TMViV replacement in young patients with RHD.

Methods: A single-centre, retrospective review of prospectively collected data on patients undergoing TMViV from December 2017 to June 2021. Primary outcome was major adverse cardiovascular events. Secondary outcome was post-operative trans-thoracic echocardiogram (TTE) results.

Results: There were seven patients with a mean age of 33 years and predominantly female (n = 5). Pre-operative comorbidities included diabetes (29%), chronic obstructive pulmonary disease (43%), left ventricular dysfunction (43%) and current smoking status (80%). Post-operative median length of hospital stay was 4 days with no post-operative renal failure, stroke, return to theatre, valve embolization or in hospital mortality. Post-operative TTE showed either nil or trivial central mitral regurgitation, no paravalvular leak and a median gradient of 5 mmHg (IQR 4.5, 7) across the new bioprosthesis; sustained at median follow-up of 22 months.

Conclusion: Current literature of TMViV replacement is focused on an older population with concurrent comorbidities. This study provides a unique insight into TMViV replacement in a young cohort of patients with complex social and geographical factors which sometimes prohibits the use of a mechanical valve. The prevalence of RHD remains high for Aboriginal and Torres Strait Islanders, planning for future repeat valve operations should be considered from the outset. We consider TMViV as a part of a staged procedural journey for young patients with RHD.

Keywords: aboriginal and Torres Strait Islander; degenerated bioprosthesis; rheumatic heart disease; transcatheter mitral valve-in-valve.

PubMed Disclaimer

References

    1. Hu J, Chen Y, Cheng S et al. Transcatheter mitral valve implantation for degenerated mitral bioprostheses or failed surgical annuloplasty rings: a systematic review and meta-analysis. J. Card. Surg. 2018; 33: 508-19.
    1. Sengupta A, Yazdchi F, Alexis SL et al. Reoperative mitral surgery versus Transcatheter mitral valve replacement: a systematic review. J. Am. Heart Assoc. 2021; 10: 1-13.
    1. Bourguignon T, Bouquiaux-Stablo AL, Loardi C 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: 2004-11.
    1. Foster A, Greenberg A, Underhill D, McIntosh C, Clark R. Intrinsic failure of Hancock mitral bioprostheses: 10- to 15-year experience. Ann. Thorac. Surg. 1987; 44: 568-77.
    1. Keenan NM, Newland RF, Baker RA, Rice GD, Bennetts JS. Outcomes of redo valve surgery in indigenous Australians. Heart Lung Circ. 2019; 28: 1102-11.

MeSH terms

LinkOut - more resources