Balloon Fracture of a Surgical Mitral Bioprosthesis During Valve-in-Valve Transcatheter Mitral Valve Replacement

Abstract

HomeCirculation: Cardiovascular InterventionsVol. 11, No. 1Balloon Fracture of a Surgical Mitral Bioprosthesis During Valve-in-Valve Transcatheter Mitral Valve Replacement Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessCase ReportPDF/EPUBBalloon Fracture of a Surgical Mitral Bioprosthesis During Valve-in-Valve Transcatheter Mitral Valve ReplacementFirst-in-Human Report Tsuyoshi Kaneko, MD, Bryan Piccirillo, MD, Harsh Golwala, MD, Agnieszka Trzcinka, MD, Charles Nyman, MD, Douglas Shook, MD, Marc Pelletier, MD, Natalia Berry, MD, Piotr Sobieszczyk, MD and Pinak Shah, MD Tsuyoshi KanekoTsuyoshi Kaneko From the Division of Cardiac Surgery (T.K., M.P.), Division of Cardiovascular Medicine (B.P., H.G., N.B., P. Sobieszczyk, P. Shah), and Division of Cardiac Anesthesia (A.T., C.N., D.S.), Brigham and Women's Hospital, Boston, MA. , Bryan PiccirilloBryan Piccirillo From the Division of Cardiac Surgery (T.K., M.P.), Division of Cardiovascular Medicine (B.P., H.G., N.B., P. Sobieszczyk, P. Shah), and Division of Cardiac Anesthesia (A.T., C.N., D.S.), Brigham and Women's Hospital, Boston, MA. , Harsh GolwalaHarsh Golwala From the Division of Cardiac Surgery (T.K., M.P.), Division of Cardiovascular Medicine (B.P., H.G., N.B., P. Sobieszczyk, P. Shah), and Division of Cardiac Anesthesia (A.T., C.N., D.S.), Brigham and Women's Hospital, Boston, MA. , Agnieszka TrzcinkaAgnieszka Trzcinka From the Division of Cardiac Surgery (T.K., M.P.), Division of Cardiovascular Medicine (B.P., H.G., N.B., P. Sobieszczyk, P. Shah), and Division of Cardiac Anesthesia (A.T., C.N., D.S.), Brigham and Women's Hospital, Boston, MA. , Charles NymanCharles Nyman From the Division of Cardiac Surgery (T.K., M.P.), Division of Cardiovascular Medicine (B.P., H.G., N.B., P. Sobieszczyk, P. Shah), and Division of Cardiac Anesthesia (A.T., C.N., D.S.), Brigham and Women's Hospital, Boston, MA. , Douglas ShookDouglas Shook From the Division of Cardiac Surgery (T.K., M.P.), Division of Cardiovascular Medicine (B.P., H.G., N.B., P. Sobieszczyk, P. Shah), and Division of Cardiac Anesthesia (A.T., C.N., D.S.), Brigham and Women's Hospital, Boston, MA. , Marc PelletierMarc Pelletier From the Division of Cardiac Surgery (T.K., M.P.), Division of Cardiovascular Medicine (B.P., H.G., N.B., P. Sobieszczyk, P. Shah), and Division of Cardiac Anesthesia (A.T., C.N., D.S.), Brigham and Women's Hospital, Boston, MA. , Natalia BerryNatalia Berry From the Division of Cardiac Surgery (T.K., M.P.), Division of Cardiovascular Medicine (B.P., H.G., N.B., P. Sobieszczyk, P. Shah), and Division of Cardiac Anesthesia (A.T., C.N., D.S.), Brigham and Women's Hospital, Boston, MA. , Piotr SobieszczykPiotr Sobieszczyk From the Division of Cardiac Surgery (T.K., M.P.), Division of Cardiovascular Medicine (B.P., H.G., N.B., P. Sobieszczyk, P. Shah), and Division of Cardiac Anesthesia (A.T., C.N., D.S.), Brigham and Women's Hospital, Boston, MA. and Pinak ShahPinak Shah From the Division of Cardiac Surgery (T.K., M.P.), Division of Cardiovascular Medicine (B.P., H.G., N.B., P. Sobieszczyk, P. Shah), and Division of Cardiac Anesthesia (A.T., C.N., D.S.), Brigham and Women's Hospital, Boston, MA. Originally published8 Jan 2018https://doi.org/10.1161/CIRCINTERVENTIONS.117.006273Circulation: Cardiovascular Interventions. 2018;11:e006273IntroductionA 65-year-old female underwent coronary artery bypass grafting plus mitral valve replacement (MVR) with a 25-mm Epic bioprosthesis (Abbott, Santa Ana, CA). Postoperatively, she was readmitted with congestive heart failure exacerbation. Transthoracic echocardiogram showed mean prosthetic gradient of 18 mm Hg raising concern for early valve deterioration. She was deemed high risk for surgery. Therefore, transseptal transcatheter valve-in-valve MVR with a 23-mm Sapien3 valve (Edwards Lifesciences, Irvine, CA) was performed 15 months post-MVR. Postimplantation transesophageal echocardiogram showed decrease in the mean gradient to 10 mm Hg. She returned 5 months later with congestive heart failure exacerbation, and transthoracic echocardiogram showed an increasing gradient to 17 mm Hg.She was brought back for an attempt at balloon fracture of the mitral bioprosthesis transseptally. Under rapid pacing, a 24-mm noncompliant balloon was used to fracture the bioprosthesis (Figure [A]). Because of suboptimal reduction in mean gradient, a 26-mm noncompliant balloon was then inflated under rapid ventricular pacing (Movie I in the Data Supplement; Figure [B]). Fracture was confirmed by the release of the balloon waist on fluoroscopy and sudden drop in the inflation pressure. Severe mitral regurgitation was noted on transesophageal echocardiogram, hence new 23 mm Sapien3 valve was implanted. The mitral gradient was reduced to 5 mm Hg by catheterization. She was discharged home on postoperative day 3 with near-complete resolution of dyspnea.Download figureDownload PowerPointFigure. High-pressure balloon inflation fracturing the mitral bioprosthesis. A, Balloon inflation of the 24-mm noncompliant balloon pre-fracturing. B, Fractured mitral prosthesis with the 26-mm noncompliant balloon. The waist of the valve is less significant after the fracture.Transcatheter valve-in-valve MVR is an acceptable treatment option for high surgical risk patients with deteriorated mitral bioprostheses.1 However, high residual gradient after valve-in-valve for small bioprosthetic valves remains a limitation of the procedure. Recently, aortic bioprosthetic valve fracture with a high-pressure balloon has been described to overcome this problem.2 We report the first case of bioprosthetic valve fracture in the mitral position.DisclosuresDrs Kaneko and Shah are Proctor/Educator at Edwards Lifesciences and Abbott. Dr Pelletier is a Consultant at Abbott and LivaNova. The other authors report no conflicts.FootnotesGuest Editor for this article was Luis A. Guzman, MD.The Data Supplement is available at http://circinterventions.ahajournals.org/lookup/suppl/doi:10.1161/CIRCINTERVENTIONS.117.006273/-/DC1.Correspondence to Tsuyoshi Kaneko, MD, Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA. E-mail [email protected]References1. Yoon SH, Whisenant BK, Bleiziffer S, Delgado V, Schofer N, Eschenbach L, Fujita B, Sharma R, Ancona M, Yzeiraj E, Cannata S, Barker C, Davies JE, Frangieh AH, Deuschl F, Podlesnikar T, Asami M, Dhoble A, Chyou A, Masson JB, Wijeysundera HC, Blackman DJ, Rampat R, Taramasso M, Gutierrez-Ibanes E, Chakravarty T, Attizzani GF, Kaneko T, Wong SC, Sievert H, Nietlispach F, Hildick-Smith D, Nombela-Franco L, Conradi L, Hengstenberg C, Reardon MJ, Kasel AM, Redwood S, Colombo A, Kar S, Maisano F, Windecker S, Pilgrim T, Ensminger SM, Prendergast BD, Schofer J, Schaefer U, Bax JJ, Latib A, Makkar RR. Transcatheter mitral valve replacement for degenerated bioprosthetic valves and failed annuloplasty rings.J Am Coll Cardiol. 2017; 70:1121–1131. doi: 10.1016/j.jacc.2017.07.714.CrossrefMedlineGoogle Scholar2. Allen KB, Chhatriwalla AK, Cohen DJ, Saxon JT, Aggarwal S, Hart A, Baron S, Davis JR, Pak AF, Dvir D, Borkon AM. Bioprosthetic valve fracture to facilitate transcatheter valve-in-valve implantation.Ann Thorac Surg. 2017; 104:1501–1508. doi: 10.1016/j.athoracsur.2017.04.007.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Simonato M, Forrest J and Dvir D (2021) The Dos and Don'ts of Mitral Valve-in-Valve and Valve-in-Ring, Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 10.1177/15569845211048940, 16:5, (402-408), Online publication date: 1-Sep-2021. Engel Gonzalez P, Turer A, Doolabh N, Jessen M and Kumbhani D (2021) Preemptive Alcohol Septal Ablation Prior to Valve-in-Valve Transcatheter Mitral Valve Replacement With Bioprosthetic Balloon Fracture, JACC: Case Reports, 10.1016/j.jaccas.2020.12.021, 3:3, (366-369), Online publication date: 1-Mar-2021. Sreedharan S, Sellers S, Ihdayhid A, Landes U, Blanke P, Allen K, Chhatriwalla A, Pibarot P, Wood D, Webb J, Leipsic J and Sathananthan J (2021) Bioprosthetic Valve Fracture to Facilitate Valve-in-Valve Transcatheter Aortic Valve Replacement, Structural Heart, 10.1080/24748706.2020.1844354, 5:1, (24-38), Online publication date: 1-Jan-2021. 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Nyman C, Shook D and Shernan S (2018) Percutaneous Techniques, Limitations and Challenges for the Failed Surgical Mitral Intervention, Seminars in Cardiothoracic and Vascular Anesthesia, 10.1177/1089253218812425, 23:1, (48-56), Online publication date: 1-Mar-2019. Hu J, Chen Y, Cheng S, Zhang S, Wu K, Wang W and Zhou Y (2018) Transcatheter mitral valve implantation for degenerated mitral bioprostheses or failed surgical annuloplasty rings: A systematic review and meta-analysis, Journal of Cardiac Surgery, 10.1111/jocs.13767, 33:9, (508-519), Online publication date: 1-Sep-2018. January 2018Vol 11, Issue 1 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.117.006273PMID: 29311291 Originally publishedJanuary 8, 2018 Keywordscoronary artery bypassmitral valveechocardiographyfemaleheart failurePDF download Advertisement SubjectsCatheter-Based Coronary and Valvular Interventions