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'Minimalist approach' for transcatheter mitral valve replacement using intracardiac echocardiography and conscious sedation: a case series.
Eur Heart J Case Rep. 2020 Jun; 4(3):1-5.EH

Abstract

Background

Transcatheter aortic valve implantation operators have adapted to a less invasive technique by foregoing the use of general anaesthesia and transoesophageal echocardiography. This is known as a 'minimalist approach'. This approach has yet to be explored in transcatheter mitral valve replacement (TMVR). Two patients with high perioperative risk underwent TMVR using only monitored conscious sedation (CS) and intracardiac echocardiography (ICE).

Case summary

The patients were symptomatic and required treatment of severe mitral regurgitation and severe mitral stenosis in a mitral valve ring and prosthetic mitral valve, respectively. With the use of an antegrade transseptal approach, the procedure was conducted under CS using ICE only. After placement of the prosthetic mitral valve, the valve was assessed by advancing the ICE catheter through the interatrial septal defect and no significant paravalvular leak occurred. In one case, ad hoc treatment of right to left shunting was successfully pursued. Valve function was excellent immediately and at 24 h after implantation and resulted in significant haemodynamic improvement.

Conclusion

With more TMVR cases being conducted, the 'minimalist approach' with CS and ICE may be considered in selected cases.

Authors+Show Affiliations

Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Florida, 2590 Cleveland Clinic Blvd, Weston, FL 33331, USA.Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Florida, 2590 Cleveland Clinic Blvd, Weston, FL 33331, USA.Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Florida, 2590 Cleveland Clinic Blvd, Weston, FL 33331, USA.Department of Cardiology, Heart & Vascular Institute, Cleveland Clinic Florida, 2590 Cleveland Clinic Blvd, Weston, FL 33331, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32617475

Citation

Cubeddu, Robert J., et al. "'Minimalist Approach' for Transcatheter Mitral Valve Replacement Using Intracardiac Echocardiography and Conscious Sedation: a Case Series." European Heart Journal. Case Reports, vol. 4, no. 3, 2020, pp. 1-5.
Cubeddu RJ, Sarkar A, Navas V, et al. 'Minimalist approach' for transcatheter mitral valve replacement using intracardiac echocardiography and conscious sedation: a case series. Eur Heart J Case Rep. 2020;4(3):1-5.
Cubeddu, R. J., Sarkar, A., Navas, V., & Navia, J. L. (2020). 'Minimalist approach' for transcatheter mitral valve replacement using intracardiac echocardiography and conscious sedation: a case series. European Heart Journal. Case Reports, 4(3), 1-5. https://doi.org/10.1093/ehjcr/ytaa058
Cubeddu RJ, et al. 'Minimalist Approach' for Transcatheter Mitral Valve Replacement Using Intracardiac Echocardiography and Conscious Sedation: a Case Series. Eur Heart J Case Rep. 2020;4(3):1-5. PubMed PMID: 32617475.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 'Minimalist approach' for transcatheter mitral valve replacement using intracardiac echocardiography and conscious sedation: a case series. AU - Cubeddu,Robert J, AU - Sarkar,Abdullah, AU - Navas,Viviana, AU - Navia,Jose L, Y1 - 2020/04/24/ PY - 2019/09/07/received PY - 2019/10/10/revised PY - 2020/02/06/accepted PY - 2020/7/4/entrez PY - 2020/7/4/pubmed PY - 2020/7/4/medline KW - Case report KW - Intracardiac echocardiography KW - Minimalist approach KW - Transcatheter mitralvalve-in-valve KW - Valve-in-ring SP - 1 EP - 5 JF - European heart journal. Case reports JO - Eur Heart J Case Rep VL - 4 IS - 3 N2 - Background: Transcatheter aortic valve implantation operators have adapted to a less invasive technique by foregoing the use of general anaesthesia and transoesophageal echocardiography. This is known as a 'minimalist approach'. This approach has yet to be explored in transcatheter mitral valve replacement (TMVR). Two patients with high perioperative risk underwent TMVR using only monitored conscious sedation (CS) and intracardiac echocardiography (ICE). Case summary: The patients were symptomatic and required treatment of severe mitral regurgitation and severe mitral stenosis in a mitral valve ring and prosthetic mitral valve, respectively. With the use of an antegrade transseptal approach, the procedure was conducted under CS using ICE only. After placement of the prosthetic mitral valve, the valve was assessed by advancing the ICE catheter through the interatrial septal defect and no significant paravalvular leak occurred. In one case, ad hoc treatment of right to left shunting was successfully pursued. Valve function was excellent immediately and at 24 h after implantation and resulted in significant haemodynamic improvement. Conclusion: With more TMVR cases being conducted, the 'minimalist approach' with CS and ICE may be considered in selected cases. SN - 2514-2119 UR - https://www.unboundmedicine.com/medline/citation/32617475/'Minimalist_approach'_for_transcatheter_mitral_valve_replacement_using_intracardiac_echocardiography_and_conscious_sedation:_a_case_series DB - PRIME DP - Unbound Medicine ER -
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