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Transcatheter Valve-in-Valve Implantation in Patients with Degenerated Bioprostheses in Mitral Position
Moritz Seiffert, Lenard Conradi, Stephan Baldus, Johannes Schirmer, Patrick Diemert, Malgorzata Knap, Renate Schnabel, Stefan Blankenberg, Hermann Reichenspurner, Hendrik Treede.
University Heart Center Hamburg, Hamburg, Germany.
BACKGROUND:
Reoperative mitral valve replacements for degenerated bioprostheses are associated with a high morbidity and mortality. Transcatheter techniques may evolve as complementary approaches to surgery in these high-risk patients. We report our experience with transcatheter mitral valve-in-valve implantations.
METHODS:
Six patients (age 75±15 years) received transapical implantation of a balloon-expandable pericardial heart valve into a degenerated bioprosthesis (range 27-31 mm) in mitral position at our institution. All patients were considered high-risk for surgical valve replacement (logistic EuroSCORE 33±15%) after evaluation by an interdisciplinary heart team. Procedural and clinical outcomes were analyzed.
RESULTS:
Implantation was successful in all patients with reduction of mean transvalvular gradients from 11.3±5.2mmHg to 5.5±3.6mmHg (p=0.016) and median regurgitation from grade 3.0 (interquartile range [IQR] 2.7 to 3.1) to 0 (IQR 0 to 1.0, p=0.033) with trace paravalvular regurgitation remaining in two patients. Apical bleeding occurred in two patients requiring rethoracotomy in one and resuscitation in a second patient, the latter of whom deceased on postoperative day 6. In the remaining patients, median NYHA-class improved from 3.0 (IQR 3.0 to 3.5) to 2.0 (IQR 1.5 to 2.0, p=0.048) over a median follow-up of 70 (IQR 25.5 to 358) days.
CONCLUSIONS:
With acceptable results in a high-risk population, transcatheter mitral valve-in-valve implantation can be considered as a complementary approach to reoperative mitral valve surgery in select patients.
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