Staged total percutaneous treatment of aortic valve pathology and mitral regurgitation: institutional experience

Catheter Cardiovasc Interv. 2013 Oct 1;82(4):E552-63. doi: 10.1002/ccd.24809. Epub 2013 May 25.


Objectives: To summarize our single Institution experience with staged total percutaneous management of aorto-mitral pathology.

Background: Percutaneous treatment of aortic valve stenosis (AVS) and mitral valve regurgitation (MVR) has been recently proposed for patients at high surgical risk.

Methods: Data concerning consecutive patients undergoing percutaneous transcatheter AV implantation (TAVI) followed by MV repair with MitraClip® were prospectively collected and analyzed.

Results: From January 2010 to February 2012 a total of 254 patients were referred to undergo TAVI in our Institution. Seventeen (6.7%) had preoperative severe MVR that remained unchanged after TAVI. Due to exacerbation of symptoms 12 patients were subsequently submitted to MV repair with the MitraClip® device. Mean age was 79 years (72-86 years), median Ambler score was 30.1 (17.2-42.6) and EuroSCORE 22.3 (10.2-48.6). Procedural success rate was 100%. Postprocedural hospitalization was 7.1 ± 2.7 and 4.6 ± 0.9 days after TAVI and MV repair, respectively. Six months follow-up echocardiography confirms improvement in LV-EF (37.2 ± 9.9 vs. 43.5 ± 10.7, P < 0.0001). No patient presents MVR exceeding grade I(+) or prosthetic aortic insufficiency > I grade and all patients experienced an improvement in functional status.

Conclusions: Percutaneous treatment of AVS and MVR is feasible and safe. A tailored approach should be considered to treat firstly the AVS and subsequently the MVR when severe MV dysfunction and symptoms persist. Short-term durability of this combined percutaneous approach seems encouraging and justifies the economical burden to treat patients that have no other option.

Keywords: CHF, congestive heart failure; IMCT, imaging (CT); VALV; valvular heart disease.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / pathology*
  • Aortic Valve / physiopathology
  • Aortic Valve Insufficiency / etiology
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / therapy*
  • Cardiac Catheterization* / adverse effects
  • Cardiac Catheterization* / instrumentation
  • Echocardiography, Doppler, Color
  • Feasibility Studies
  • Female
  • Germany
  • Heart Valve Prosthesis Implantation / adverse effects
  • Heart Valve Prosthesis Implantation / instrumentation
  • Heart Valve Prosthesis Implantation / methods*
  • Humans
  • Length of Stay
  • Male
  • Mitral Valve Insufficiency / diagnosis
  • Mitral Valve Insufficiency / physiopathology
  • Mitral Valve Insufficiency / therapy*
  • Prospective Studies
  • Severity of Illness Index
  • Stroke Volume
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Ventricular Function, Left