Initial Experience With a Percutaneous Approach to Redo Mitral Valve Surgery: Management and Procedural Success

ObjectiveThe purpose of the study was to report the anesthetic management and immediate procedural success in the initial 20 patients undergoing percutaneous transapical mitral valve replacement.DesignRetrospective review of collected data.SettingUniversity-affiliated heart center.ParticipantsTwenty patients with mitral regurgitation or stenosis due to a degenerated valve or ring in the mitral position.InterventionsTEE-guided transapical mitral valve replacement under general anesthesia and early extubation by means of an established fast-track protocol.Measurements and Main MethodsTwenty patients underwent transapical mitral valve replacement by a beating heart procedure, avoiding cardiopulmonary bypass. The valve was either deployed due to a previously implanted bioprosthetic valve (valve-in-valve group), which degenerated, or a ring (valve-in-ring group), which predominantly showed regurgitation. There was a significant increase in the mitral valve opening area in stenosed valve pathology from 1.3-1.9 sq. cm (p = 0.004), and an increase in ejection fraction from 40% to 45% (p = 0.52). In the valve-in-ring group, valve area increased from 2.0 sq. cm to 2.6 sq. cm (p = 0.21), with an increase in ejection fraction from 30% to 35% (p = 0.18). Eighteen patients underwent successful deployment of the valve. The anesthesia duration for the procedure lasted 185.5±25.4 minutes.ConclusionsThere was a significant increase in opening area of the valve and improvement in ejection fraction in this patient group. TEE and fluoroscopy-guided imaging is necessary for the procedure’s success and is an evolving alternative treatment for high-risk mitral valve patients who would otherwise be considered inoperable for routine surgery using sternotomy.