PMID- 37719001
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230920
IS  - 2514-2119 (Electronic)
IS  - 2514-2119 (Linking)
VI  - 7
IP  - 9
DP  - 2023 Sep
TI  - Trans-catheter mitral valve-in-valve replacement in a patient on venoarterial 
      extracorporeal membrane oxygenation: a case report.
PG  - ytad427
LID - 10.1093/ehjcr/ytad427 [doi]
LID - ytad427
AB  - BACKGROUND: Bioprosthetic mitral valves on average have a median durability 
      between 8 and 10 years. After the failure of a bioprosthetic valve, surgical 
      replacement is often indicated. However, the options for those patients at high 
      or prohibitive surgical risks are limited. Here, we describe a case of a 
      successful trans-catheter mitral valve-in-valve (TMViV) replacement on 
      venoarterial extracorporeal membrane oxygenation (VA-ECMO). CASE SUMMARY: We 
      describe a case of a 39-year-old female with a history notable for systemic lupus 
      erythematosus, severe pulmonary arterial hypertension (now mixed pre and post) 
      thought to be secondary to prior substance use, and infective endocarditis 
      complicated by severe mitral stenosis status post-bioprosthetic mitral valve 
      replacement who presented with symptoms of acute hypoxic respiratory failure 
      secondary to severe bioprosthetic mitral valve stenosis. The patient had a 
      prolonged hospital course complicated by a pulseless electrical activity arrest, 
      (continuous renal replacement therapy) for acute renal failure, and hypertonic 
      saline due to cerebral oedema. Due to her significant co-morbidities and 
      haemodynamic instability with acute kidney injury and recent neurologic insult, 
      the patient was thought not to be a good surgical candidate. However, given her 
      young age and overall improved neurologic status, it was thought the patient 
      could benefit from a TMViV with bi-ventricular support given her right- and 
      left-sided heart failure and was placed on VA-ECMO in anticipation of a TMViV 
      procedure for circulatory support. The patient underwent a successful TMViV 
      replacement using a trans-septal approach with a 26 mm SAPIEN 3 valve and atrial 
      septal defect closure with a 14 mm Amplatzer device on hospital Day 12. The 
      patient was successfully de-cannulated from VA-ECMO on hospital Day 13. The 
      patient had a prolonged hospital course but eventually had renal recovery and 
      tracheostomy de-cannulation. A trans-thoracic echocardiogram prior to discharge 
      was notable for a well-functioning valve and normal ejection fraction. The 
      patient was discharged to a nursing home for further rehabilitation. DISCUSSION: 
      The gold standard for bioprosthetic mitral valve stenosis is surgical replacement 
      of the valve. However, the options for those at high or prohibitive surgical risk 
      are lacking. Recent studies have demonstrated TMViV is a safe alternative to 
      surgical mitral valve redo cases in high-risk patients. To our knowledge, there 
      are limited data on trans-catheter valve placement while on VA-ECMO. Successful 
      implantation in our patient suggests that TMViV in a stenotic bioprosthesis is 
      feasible in very high-risk patients with the use of VA-ECMO to support 
      haemodynamics.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the 
      European Society of Cardiology.
FAU - Bainiwal, Jassimran Singh
AU  - Bainiwal JS
AUID- ORCID: 0000-0002-1685-5455
AD  - Department of Medicine, UCLA Medical Center, Los Angeles, CA 90095, USA.
FAU - Ham, Jeremy-Ann
AU  - Ham JA
AD  - David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
FAU - Aksoy, Olcay
AU  - Aksoy O
AD  - Division of Cardiology, Department of Medicine, UCLA Medical Center, Los Angeles, 
      CA, USA.
LA  - eng
PT  - Case Reports
DEP - 20230901
PL  - England
TA  - Eur Heart J Case Rep
JT  - European heart journal. Case reports
JID - 101730741
PMC - PMC10500414
OTO - NOTNLM
OT  - Interventional cardiology
OT  - Mitral stenosis
OT  - Trans-catheter mitral valve replacement
OT  - VA-ECMO
COIS- Conflict of interests: None declared.
EDAT- 2023/09/18 06:42
MHDA- 2023/09/18 06:43
PMCR- 2023/09/01
CRDT- 2023/09/18 04:14
PHST- 2023/04/12 00:00 [received]
PHST- 2023/06/24 00:00 [revised]
PHST- 2023/08/30 00:00 [accepted]
PHST- 2023/09/18 06:43 [medline]
PHST- 2023/09/18 06:42 [pubmed]
PHST- 2023/09/18 04:14 [entrez]
PHST- 2023/09/01 00:00 [pmc-release]
AID - ytad427 [pii]
AID - 10.1093/ehjcr/ytad427 [doi]
PST - epublish
SO  - Eur Heart J Case Rep. 2023 Sep 1;7(9):ytad427. doi: 10.1093/ehjcr/ytad427. 
      eCollection 2023 Sep.