Background: The percutaneous approach for a failed bio-prosthetic valve is an alternative to redo-valve surgery in patients at high surgical risk. We aim to describe the treatment of patients with structural bio-prosthetic valve deterioration using the valve-in-valve technique.
Methods: We report our clinical experience in treating 38 consecutive patients with symptomatic structural bio-prosthetic valve deterioration using the valve-in-valve technique.
Results: The valve-in-valve procedure in the aortic position was performed in 27 patients, mean age 80.8±9.8 years, mean STS score 9.4±5.1. The Medtronic Corevalve® , the Medtronic Evolut_R® and the Edwards Sapien® device was used in 24 (89%), 1 (3.7%) and 2 (8.7%) cases; respectively. Procedures were performed via the trans-femoral, trans-axillary and trans-apical routes in 22 (81%), 3 (11%) and 2 (7.4%) cases; respectively. After the procedure 100% of patients were in NYHA-FC I/II. Survival rates were 100% and 92.6% at 1 months and one year follow-up; respectively.
Valve-in-Valve in the mitral positionwas performed in 10 patients, mean age 73.6 ± 15 years. NYHA III/IV before the procedure was present in 100% of patients. Mean STS score was 7.7 ± 4.1. Mode of failure was severe mitral regurgitation in 100% of cases. All the procedures were performed with the Edwards-Sapien device via the trans-apical route. Procedural success was achieved in 100% of cases. One month and one year survival rates were 90% and 80%; respectively. At one month follow up, 100% of patients were in NYHA I/II.
Valve-in-Valve in the tricuspid position, was performed in a 78 year-old female patient. The patient was in NYHA IV secondary to severe tricuspid stenosis due to the deterioration of a bioprosthetic Handcock 31mm valve. An Edwards-Sapien 29mm valve was implanted via the trans-femoral vein route. The procedure went uneventful. At one month follow up the patient was in NYHA-FC II.
Conclusions: In our experience the valve-in-valve technique for the treatment of a wide range of bio-prosthetic valve deterioration modes of failure in different valve positions is safe, effective and led to significant symptomatic improvement
