Transcatheter Aortic Valve Replacement as a bridge to minimally invasive endoscopic mitral valve surgery in Elderly Patients in the era of ERAS and Fast Track TAVI concepts

Author:

Owais Tamer12,Bisht Osama3,Polat Emre1ORCID,Abdelmoteleb Noureldin1,El Garhy Mohammad4,Lauten Phillip5,Kuntze Thomas5,Girdauskas Evaldas1

Affiliation:

1. Department of Cardiac Surgery, University Hospital Augsburg, 86156 Augsburg, Germany

2. Department of Cardiothoracic Surgery, Cairo University, Giza P.O. Box 12613, Egypt

3. Department of Cardiology and Angiology, Regiomed Klinikum Coburg, 3396450 Coburg, Germany

4. Department of Cardiology, Helios Clinic Erfurt, 99089 Erfurt, Germany

5. Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany

Abstract

In this bicentric study, we report the outcomes of combined transcatheter aortic valve replacement combined with minimally invasive mitral valve surgery. We included a cohort of six patients (79.6 ± 3.2 years, 83% women) with high-risk profiles and deemed to be non-operable with combined mitral and aortic valvular disease. All patients had unsuitable anatomies for transcatheter mitral valve edge-to-edge repair (TEER). Moreover, most of the patients (5/6) suffered a combined aortic valve lesion, which complicates the efficiency of cardioplegia in the case of CBP through minimally invasive incisions. The first stage was implanting a TAVI valve to achieve aortic valve competency and hence facilitate the infusion of cardioplegia after clamping the aorta during endoscopic mitral valve surgery. After one week, we performed the minimally invasive mitral valve repair. Most patients (n = 5; 83%) underwent successful endoscopic mitral valve repair. Intraoperatively, the mean ischemic time was 42 min, and the total bypass time was 72 min. Postoperatively, the mean intubation time was 0 h. Postoperative complications included reoperation for bleeding in one patient (16.7%) and a new heart block requiring pacemaker implantation in one patient (16.7%). There was neither in-hospital mortality nor 1-year mortality.

Funder

Augsburg University, Germany

Publisher

MDPI AG

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