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J Thorac Cardiovasc Surg 2009;137:1547-1549
© 2009 The American Association for Thoracic Surgery

Brief Communication

Mitral valve injury late after transcatheter aortic valve implantation

^a Division of Cardiac Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
^b Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
^c Department of Pathology and Laboratory Medicine, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada

Received for publication March 30, 2008; revisions received May 27, 2008; accepted for publication June 7, 2008.

^_* Address for reprints: John G. Webb, MD, McLeod Professor of Heart Valve Disease Intervention, and Director, Interventional Cardiology, St Paul's Hospital, Room 5202A, 1081 Burrard St, Vancouver, BC, Canada V6Z 2E8. (Email: webb@providencehealth.bc.ca).

The first 20% of the full text of this article appears below.

Transcatheter aortic valve implantation (TAVI) is an alternative to high-risk aortic valve replacement (AVR).^1,2 There are limited data on long-term outcomes.

Clinical Summary

An 88-year-old man with symptomatic severe aortic stenosis underwent percutaneous TAVI with a 26-mm SAPIEN valve (Edwards Lifesciences LLC, Irvine, Calif). Comorbid conditions included coronary artery bypass with patent retrosternal grafts, transient ischemic attacks, bilateral carotid endarterectomies, atrial fibrillation, repaired abdominal aneurysm, prostate cancer, and renal failure. Estimated 30-day mortality for AVR was 35% by means of logistic EuroSCORE and 11.1% by means of the Society of Thoracic Surgeons National Database Risk Calculator. The procedure was performed without difficulty, but the final valve position was suboptimal, being slightly low (ventricularly), with the ventricular aspect of the stent abutting the anterior leaflet of the mitral valve (MV). Moderate paravalvular aortic regurgitation (AR) was treated with repeated balloon redilation³ without altering the valve position. Six-month transthoracic echocardiographic analysis showed trivial AR and mitral regurgitation.

The patient presented 11 months after implantation with fever and Streptococcus angiosus in blood cultures. Also noted were a dental visit 6 weeks before and lack of compliance with endocarditis prophylaxis. Transesophageal echocardiographic analysis demonstrated mild-to-moderate paravalvular AR, a 13 x . . . [Full Text of this Article]

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				J.-B. Masson, J. Kovac, G. Schuler, J. Ye, A. Cheung, S. Kapadia, M. E. Tuzcu, S. Kodali, M. B. Leon, and J. G. Webb Transcatheter Aortic Valve Implantation: Review of the Nature, Management, and Avoidance of Procedural Complications J. Am. Coll. Cardiol. Intv., September 1, 2009; 2(9): 811 - 820. [Abstract] [Full Text] [PDF]