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Transcatheter Transapical Mitral Valve-in-valve implantation : The Singapore Experience
Zameer Aziz, Jia Lin Soon.
National Heart Centre, Singapore, Singapore.

OBJECTIVE: This study reports the results of transcatheter mitral valve-in-valve implantations in our centre - to review the safety and efficacy as a complementary approach to reoperative mitral valve surgery
METHODS: We present a prospective study of 6 patients (age 59 to 85 years) who received transapical implantation of a transcatheter prosthesis in the mitral position at our institution over 4 years. All patients were considered to be at increased risk after evaluation by a interdisciplinary heart team. We analysed the outcomes with up to 2 year follow up.
RESULTS: The average STS score for the cohort was 11.85% (Range 5.46 to 22.32). The average Euroscore was 12.66 (Range 5.62 to 27.80). Implantation was successful in all patients. All patients were implanted with Sapien XT transcatheter valves: one #29, one #23 and four #26 size valves. 5 patients were implanted into previous mitral valves and 1 patient had a transcatheter valve implanted who had a previous mitral ring repair.
One patient suffered intra-operative hypotension requiring haemodynamic support.
There were no other clinically significant complications encountered.
Mean reduction in transvalvular gradients from 12.26 to 6.25 at 1 year was shown, with a corresponding decrease in mean NYHA scores.
The mean duration of hospital stay was 7.5 days (Range 6 to 13)
CONCLUSIONS: Transapical mitral valve-in-valve implantation provides a promising complementary approach to reoperative mitral valve surgery in carefully selected patients, with satisfactory clinical outcomes.

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