State-of-the-Art Review
The Art of SAPIEN 3 Transcatheter Mitral Valve Replacement in Valve-in-Ring and Valve-in-Mitral-Annular-Calcification Procedures

https://doi.org/10.1016/j.jcin.2021.08.044Get rights and content
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Highlights

  • SAPIEN 3 in mitral surgical rings or MAC is performed with inconsistent outcomes.

  • New techniques, improved procedure planning, and device modifications result in improved TMVR.

  • Purpose built devices may help proliferate TMVR in mitral rings or MAC.

Abstract

The SAPIEN 3 is the only transcatheter heart valve commercially available for compassionate transcatheter mitral valve replacement in patients with previous mitral surgical rings and mitral annular calcification (valve in ring [VIR] and valve in mitral annular calcification [VIM]). Reported outcomes have been inconsistent or poor. The review provides an overview of the authors’ approach to achieve largely consistent results despite the intrinsic limitations of SAPIEN 3 VIM and VIR. The approach includes bedside modifications of the valve implant, the delivery system, and of the cardiac substrate itself. Until purpose-built devices are readily available, VIR and VIM procedures will require aggressive multidisciplinary cooperation, meticulous planning and execution, and postprocedure management by experienced, high-volume operators.

Key Words

mitral annular calcification
LAMPOON
SAPIEN 3
transcatheter electrosurgery
transcatheter mitral valve replacement
valve-in-ring

Abbreviations and Acronyms

CT
computed tomography
IABP
intra-aortic balloon pump
LV
left ventricle/ventricular
LVH
left ventricular hypertrophy
LVOT
left ventricular outflow tract
MAC
mitral annular calcification
MR
mitral regurgitation
PVL
paravalvular leak
PEEP
positive end-expiratory pressure
TMVR
transcatheter mitral valve replacement
VIM
valve in mitral annular calcification
VIR
valve in ring

Cited by (0)

Lars Søndergaard, MD, served as Guest Editor for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.