BACKGROUND: Increasing numbers of mitral bioprosthesis are being implanted. Transcatheter valve-in-valve implantation is recommended for high-risk patients requiring redo valve surgery. We report our experience with transapical mitral valve-in-valve implantation for failed MV.
METHODS: Since 2010, 8 patients have undergone transapical transcatheter valve-in-valve implantation for failed bioprosthesis, of whom 6 (4 females) underwent mitral valve-in-valve implantation. Mean age was 82±5 years. Mean time from original MV replacement to valve-in-valve procedure was 11±3 years. Mean Logistic EuroScore mortality risk was 37±13. Follow-up was 100% completed with a mean time of 13±15 months.
RESULTS: Preoperatively, all patients presented with severe mitral regurgitation due to structural valve failure. All six patients underwent successful transapical valve-in-valve implantation with the Edwards Sapien balloon expandable valve (5 with 26mm and 1 with 29mm). There was no in-hospital mortality. Intensive care unit and ventilation times were 2.8±1.7 and 1.1±1.0 days, respectively. Mean and median hospital stay was 10±9 and 7 days, respectively. There were no major complications, such as re-open, major bleeding, low-cardiac output, CVA, or renal failure. There was one wound infection. Follow up was 100% completed and demonstrated trivia/no mitral regurgitation in five patients (83%) and mild in one (17%). Peak and mean gradients changed from 24±1 and 7±1 at baseline, to 18±7 and 10±6, at follow-up. No patient died during follow-up, and all patients are in NHYA class I or II.
CONCLUSIONS: Transcatheter transapical mitral valve-in-valve implantation is an excellent alternative to conventional redo MV surgery for failed bioprosthesis, in high-risk patients. Post procedure gradients across the MV are elevated, and may impact patient functional class, long-term survival and quality of life. Larger, randomized trials and long-term clinical and echocardiographic follow-up are warranted.
