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Pushing the limits—further evolutions of transcatheter valve procedures in the mitral position, including valve-in-valve, valve-in-ring, and valve-in-native-ring 

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Presentation on theme: "Pushing the limits—further evolutions of transcatheter valve procedures in the mitral position, including valve-in-valve, valve-in-ring, and valve-in-native-ring "— Presentation transcript:

1 Pushing the limits—further evolutions of transcatheter valve procedures in the mitral position, including valve-in-valve, valve-in-ring, and valve-in-native-ring  Manuel Wilbring, MD, Konstantin Alexiou, MD, Sems Malte Tugtekin, MD, Sebastian Arzt, MD, Karim Ibrahim, MD, Klaus Matschke, MD, Utz Kappert, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 147, Issue 1, Pages (January 2014) DOI: /j.jtcvs Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Mitral valve-in-valve procedure. The radiopaque markers of the degenerated bioprosthesis clearly indicate the landing zone and thus easy and orthograde positioning of the transcatheter heart valve. A, Positioning of the valve before inflation of the balloon. B and C, Gradual inflation of the balloon. D, Final result. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Mitral valve-in-ring procedure. A centered position of the transcatheter heart valve with equal proportions in the left ventricle and in the atrium is advocated to prevent outflow tract obstruction, paravalvular leakage, or valve embolization. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Sizing considerations for valve-in-ring procedures.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Postoperative aspect after the second look procedure. The transcatheter heart valve is implanted in the native calcified mitral annulus and secured with a running 3-0 polypropylene suture to an atrial cuff. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

6 Figure 5 Mitral valve-in-valve procedure in a patient with history of previous aortic and mitral valve replacement. The projection of both bioprostheses over each other made the procedure more demanding. In the end the presence of aortic bioprosthesis was not a drawback. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

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