Background: Transcatheter heart valve implantation is a therapeutic option for the treatment of patients with bioprosthetic valve failure. We describe our experience using this technique in the treatment of degenerated mitral and aortic bioprosthetic valves.
Methods: 28 patients underwent a valve-in-valve (VIV) implantation using both the Edwards-Sapien and the Corevalve devices. The VIV procedure was performed in 8 atients for the treatment of bioprosthetic mitral valve (BMV) deterioration and in 20 patients for the treatment of bioprosthetic aortic valve (BAV) deterioration.
Results: Mean follow up was 545±375 and 513±421 days for patients with degenerated BMV and BAV; respectively. The mean age was 70.6±15.2 years in patients with BMV failure and 81.4±6.1 years in those with BAV failure. Mean Euroscore and STS score was 20.3±13.4 and 8.6±4.6 in patients with BMV degeneration; respectively and 27.7±15.4 and 9.7±5.6 in those with BAV deterioration; respectively. Procedural success was achieved in 100% of the cases in both groups. A second percutaneous valve implantation was required in two (10%) patients with a degenerated BAV. In 10/20 patients from the group with a degenerated BAV the cause of bioprosthetic valve failure was severe aortic stenosis. In this sub-group of patients the mean gradient decrease from 42.7±12.8 to 17.8±13.5 mmHg. In those patients with predominant aortic regurgitation (10/20), reduction in aortic regurgitation was achieved in all cases. In 8/8 patients with a degenerated BMV the cause of bioprosthetic deterioration was severe mitral regurgitation, after the VIV procedure a reduction of the mitral regurgitation was achieved in all 8 cases. One patient (12.5%) in the BMV deterioration group died in-hospital after 35 days. All other 27 patients were alive at 30 and 180 days follow up.
Conclusions: According to our experience, the VIV procedure is feasible and obviates the need for re-do valve replacement surgery.
