Transcatheter mitral valve replacement: HighLife
Nicolo PiazzaMD, PhD, FRCPC, FESC, FACC
McGill University Health Center, Montreal, CanadaINSELSPITAL, Bern University Hospital, Bern, Switzerland
Mitral Valve MeetingZurich, Switzerland
Tuesday February 7, 201711:30‐11:38 am
HighLife “Valve‐in‐Ring” concept
Atrial Ventricular
Chronic animal explant 3 months
2‐step procedure
+Transfemoral artery
=Transapical or transseptal
“Valve‐in‐Ring” Ring Valve
Valve function at 7 days
Mean MV gradient 3 mmHG
Mean LVOT gradient 2 mmHg
Early clinical experience (n=8)
Safety & feasibility study
(n=4)
Compassionate or Special access
(n=4)
Demographics
Age (years), avg. (range) 68 (50‐79)
Male (%) 75
Functional MR (%) 75
Previous cardiac surgery (%) 38
LVEF (%), avg. (range) 33 (25‐50)
Annular diameter (mm), range 32‐48
• 100% success• 3 patients with > 6 months follow‐up• 1 patient with 3 month follow‐up
• n= 1 successful implant(poor LV function 25%, in‐hospital death)
• n = 1 successful implant (> 6 months follow‐up)
• n= 1 conversion to surgery (for chordal entanglement, in‐hospital death)
• n = 1 conversion to surgery (chordal entanglement, > 1 month follow‐up)
Early clinical experience (n=8)
Safety & feasibility study
(n=4)
Compassionate or Special access
(n=4)
Potential areas of entanglement – verification tests
Posterior basal chords Submitral apparatus (chords)
Case 1 Case 7
Case 1 Case 2
Case 3 Case 4
Case 5 Case 6
Take‐home messages
• Echocardiography is instrumental to verify loop positioning
• Procedure is feasible with good end result (no paravalvular leaks, mean transmitral gradients < 5 mmHG, low left ventricular outflow tract gradients < 8 mmHg)
• Current design can accommodate a large annular range (32‐48)
• Self‐centering and does not require rotational positioning makes transseptal delivery very feasible