Thrombotic valvular dysfunction with transcatheter mitral interventions for postsurgical failures

Marvin H. Eng, Adam Greenbaum, Dee Dee Wang, Janet Wyman, Heider Arjomand, Pradeep Yadav, Hassan Nemeh, Gaetano Paone, Mayra Guerrero, William O'Neill

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Degenerated surgical mitral valve repairs or surgical prostheses are currently being treated with transcatheter mitral valve replacement (TMVR). We report the procedural and mid-term assessment of thirteen cases. Methods: From 12/2013 to 12/2015, 13 consecutive patients with degenerated mitral valve repair or valve replacement were treated. Patients were assessed for mitral valve academic valve consortium (MVARC) defined outcomes. Results: Immediate procedural MVARC defined technical success was 92%. At 30 days MVARC device and procedure success were 61% and 84%, respectively. Mean follow-up was 150 days [IQR 40-123 days]. There were 2 late major adverse outcomes, a noncardiac related death (628 days) and a stroke (382 days). The mean mitral gradient decreased from 9.5 ± 3.4 to 5.5 ± 2.6 mm Hg (P < 0.01). Three patients were found to have high gradients, two presented with heart failure while another patient was found to have reduced leaflet motion and abnormal thickening postprocedure. The two patients with heart failure were treated with enoxaparin, which caused subsequent resolution of increased valve gradients in one patient. The other patient could not tolerate prolonged treatment from anticoagulation due to gastrointestinal bleeding. Three of 13 patients were treated with dual-antiplatelet therapy and were suspected to have valve thrombosis. Conclusion: Thrombotic related dysfunction post-TMVR occurred in 15% (2/13) of patients and one patient had abnormal leaflet thickening that may have been thrombus related. Dual-antiplatelet therapy was used in all 3 cases suggesting the possible need for oral anticoagulation postmitral valve-in-valve therapy.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - 2017
Externally publishedYes

Fingerprint

Mitral Valve
Thrombosis
Heart Failure
Enoxaparin
Therapeutics
Surgical Instruments
Prostheses and Implants
Stroke
Hemorrhage
Equipment and Supplies

Keywords

  • Mitral
  • Transapical
  • Transcatheter heart valve
  • Valve thrombosis
  • Valve-in-valve

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Thrombotic valvular dysfunction with transcatheter mitral interventions for postsurgical failures. / Eng, Marvin H.; Greenbaum, Adam; Dee Wang, Dee; Wyman, Janet; Arjomand, Heider; Yadav, Pradeep; Nemeh, Hassan; Paone, Gaetano; Guerrero, Mayra; O'Neill, William.

In: Catheterization and Cardiovascular Interventions, 2017.

Research output: Contribution to journalArticle

Eng, MH, Greenbaum, A, Dee Wang, D, Wyman, J, Arjomand, H, Yadav, P, Nemeh, H, Paone, G, Guerrero, M & O'Neill, W 2017, 'Thrombotic valvular dysfunction with transcatheter mitral interventions for postsurgical failures', Catheterization and Cardiovascular Interventions. https://doi.org/10.1002/ccd.26909
Eng, Marvin H. ; Greenbaum, Adam ; Dee Wang, Dee ; Wyman, Janet ; Arjomand, Heider ; Yadav, Pradeep ; Nemeh, Hassan ; Paone, Gaetano ; Guerrero, Mayra ; O'Neill, William. / Thrombotic valvular dysfunction with transcatheter mitral interventions for postsurgical failures. In: Catheterization and Cardiovascular Interventions. 2017.
@article{50586bc482ab4da6a8a3d21b4c5e3c12,
title = "Thrombotic valvular dysfunction with transcatheter mitral interventions for postsurgical failures",
abstract = "Background: Degenerated surgical mitral valve repairs or surgical prostheses are currently being treated with transcatheter mitral valve replacement (TMVR). We report the procedural and mid-term assessment of thirteen cases. Methods: From 12/2013 to 12/2015, 13 consecutive patients with degenerated mitral valve repair or valve replacement were treated. Patients were assessed for mitral valve academic valve consortium (MVARC) defined outcomes. Results: Immediate procedural MVARC defined technical success was 92{\%}. At 30 days MVARC device and procedure success were 61{\%} and 84{\%}, respectively. Mean follow-up was 150 days [IQR 40-123 days]. There were 2 late major adverse outcomes, a noncardiac related death (628 days) and a stroke (382 days). The mean mitral gradient decreased from 9.5 ± 3.4 to 5.5 ± 2.6 mm Hg (P < 0.01). Three patients were found to have high gradients, two presented with heart failure while another patient was found to have reduced leaflet motion and abnormal thickening postprocedure. The two patients with heart failure were treated with enoxaparin, which caused subsequent resolution of increased valve gradients in one patient. The other patient could not tolerate prolonged treatment from anticoagulation due to gastrointestinal bleeding. Three of 13 patients were treated with dual-antiplatelet therapy and were suspected to have valve thrombosis. Conclusion: Thrombotic related dysfunction post-TMVR occurred in 15{\%} (2/13) of patients and one patient had abnormal leaflet thickening that may have been thrombus related. Dual-antiplatelet therapy was used in all 3 cases suggesting the possible need for oral anticoagulation postmitral valve-in-valve therapy.",
keywords = "Mitral, Transapical, Transcatheter heart valve, Valve thrombosis, Valve-in-valve",
author = "Eng, {Marvin H.} and Adam Greenbaum and {Dee Wang}, Dee and Janet Wyman and Heider Arjomand and Pradeep Yadav and Hassan Nemeh and Gaetano Paone and Mayra Guerrero and William O'Neill",
year = "2017",
doi = "10.1002/ccd.26909",
language = "English (US)",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",

}

TY - JOUR

T1 - Thrombotic valvular dysfunction with transcatheter mitral interventions for postsurgical failures

AU - Eng, Marvin H.

AU - Greenbaum, Adam

AU - Dee Wang, Dee

AU - Wyman, Janet

AU - Arjomand, Heider

AU - Yadav, Pradeep

AU - Nemeh, Hassan

AU - Paone, Gaetano

AU - Guerrero, Mayra

AU - O'Neill, William

PY - 2017

Y1 - 2017

N2 - Background: Degenerated surgical mitral valve repairs or surgical prostheses are currently being treated with transcatheter mitral valve replacement (TMVR). We report the procedural and mid-term assessment of thirteen cases. Methods: From 12/2013 to 12/2015, 13 consecutive patients with degenerated mitral valve repair or valve replacement were treated. Patients were assessed for mitral valve academic valve consortium (MVARC) defined outcomes. Results: Immediate procedural MVARC defined technical success was 92%. At 30 days MVARC device and procedure success were 61% and 84%, respectively. Mean follow-up was 150 days [IQR 40-123 days]. There were 2 late major adverse outcomes, a noncardiac related death (628 days) and a stroke (382 days). The mean mitral gradient decreased from 9.5 ± 3.4 to 5.5 ± 2.6 mm Hg (P < 0.01). Three patients were found to have high gradients, two presented with heart failure while another patient was found to have reduced leaflet motion and abnormal thickening postprocedure. The two patients with heart failure were treated with enoxaparin, which caused subsequent resolution of increased valve gradients in one patient. The other patient could not tolerate prolonged treatment from anticoagulation due to gastrointestinal bleeding. Three of 13 patients were treated with dual-antiplatelet therapy and were suspected to have valve thrombosis. Conclusion: Thrombotic related dysfunction post-TMVR occurred in 15% (2/13) of patients and one patient had abnormal leaflet thickening that may have been thrombus related. Dual-antiplatelet therapy was used in all 3 cases suggesting the possible need for oral anticoagulation postmitral valve-in-valve therapy.

AB - Background: Degenerated surgical mitral valve repairs or surgical prostheses are currently being treated with transcatheter mitral valve replacement (TMVR). We report the procedural and mid-term assessment of thirteen cases. Methods: From 12/2013 to 12/2015, 13 consecutive patients with degenerated mitral valve repair or valve replacement were treated. Patients were assessed for mitral valve academic valve consortium (MVARC) defined outcomes. Results: Immediate procedural MVARC defined technical success was 92%. At 30 days MVARC device and procedure success were 61% and 84%, respectively. Mean follow-up was 150 days [IQR 40-123 days]. There were 2 late major adverse outcomes, a noncardiac related death (628 days) and a stroke (382 days). The mean mitral gradient decreased from 9.5 ± 3.4 to 5.5 ± 2.6 mm Hg (P < 0.01). Three patients were found to have high gradients, two presented with heart failure while another patient was found to have reduced leaflet motion and abnormal thickening postprocedure. The two patients with heart failure were treated with enoxaparin, which caused subsequent resolution of increased valve gradients in one patient. The other patient could not tolerate prolonged treatment from anticoagulation due to gastrointestinal bleeding. Three of 13 patients were treated with dual-antiplatelet therapy and were suspected to have valve thrombosis. Conclusion: Thrombotic related dysfunction post-TMVR occurred in 15% (2/13) of patients and one patient had abnormal leaflet thickening that may have been thrombus related. Dual-antiplatelet therapy was used in all 3 cases suggesting the possible need for oral anticoagulation postmitral valve-in-valve therapy.

KW - Mitral

KW - Transapical

KW - Transcatheter heart valve

KW - Valve thrombosis

KW - Valve-in-valve

UR - http://www.scopus.com/inward/record.url?scp=85012041082&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85012041082&partnerID=8YFLogxK

U2 - 10.1002/ccd.26909

DO - 10.1002/ccd.26909

M3 - Article

C2 - 28185392

AN - SCOPUS:85012041082

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

SN - 1522-1946

ER -