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DOI: 10.1055/s-0037-1598947
Valve-in-Valve Treatment of Failed Mitral Bioprosthesis in High-Risk Patients: The Future Method of Choice?
Publication History
Publication Date:
03 February 2017 (online)
Background: Redo surgery of high risk patients with degenerated mitral bio- prosthesis is associated with high morbidity and mortality. Transcatheter transapical valve-in-valve implantation is a modern option for these patients. We report our first case series using Edwards Sapien XT and Sapien 3.
Methods: Between 2014 und 2016 11 high-risk patients underwent valve-in-valve implantation of failed mitral bioprosthesis. The bioprosthesis failure was caused by stenosis in 8 and regurgitation in 3 cases. In one patient an additional paravalvular leakage was found. Mean Implantation time was found to be 6 years. Sapien XT was used in 7, Sapien S3 in 4 patients.
Results: Transapical valve-in-valve implantation of degenerated bioprosthesis (4 Sorin Pericarbon, 3 St. Jude Epic, 4 CE Perimount) was done in 11 patients (5 female, 6 male), mean age 78 ± 5 years, mean log. EuroSCORE 39 ± 16%. The procedure was successful in 100% of cases, in one case an additional closure of a paravalvular leakage was performed via implantation of an Amplatzer device. 30-day mortality was 0%; in two cases we have seen an extended postoperative course caused by renal failure and pneumonia. One superficial wound infection occurred. Postoperative mean gradient was around 6 mm Hg after valve-in-valve implantation, and no significant regurgitation was seen.
Conclusion: Transcatheter, transapical valve-in-valve implantation in degenerative mitral bioprosthesis is a safe and reproducible therapeutic option. Especially in high-risk patients, it might be the future method of choice.