Simultaneous Transcatheter Aortic and Mitral Valve-in-Valve Implantation in a Patient with Degenerated Bioprostheses and High Surgical Risk

Abstract

Transcatheter valve-in-valve implantation is evolving as a promising alternative to reoperative valve replacement in selected high-risk patients, considering the increasing need for redo surgery due to bioprosthetic degeneration in the future. Reoperative double valve replacements are particularly associated with an elevated surgical risk. The transapical access provides the opportunity to approach the aortic and mitral valves during one intervention. We report the case of a successful transcatheter valve-in-valve implantation in the aortic and mitral position within a single procedure.

Key words

transcatheter aortic valve implantation - transapical - reoperation - xenograft degeneration

References

• 1 Gummert J F, Funkat A, Beckmann A et al. Cardiac surgery in Germany during 2009. A report on behalf of the German Society for Thoracic and Cardiovascular Surgery.  Thorac Cardiovasc Surg. 2010;  58 (7) 379-386
• 2 Kempfert J, Van Linden A, Linke A et al. Transapical off-pump valve-in-valve implantation in patients with degenerated aortic xenografts.  Ann Thorac Surg. 2010;  89 (6) 1934-1941
• 3 Pasic M, Unbehaun A, Dreysse S et al. Transapical aortic valve implantation after previous aortic valve replacement: clinical proof of the “valve-in-valve” concept.  J Thorac Cardiovasc Surg. 2011;  142 (2) 270-277
• 4 Seiffert M, Franzen O, Conradi L et al. Series of transcatheter valve-in-valve implantations in high-risk patients with degenerated bioprostheses in aortic and mitral position.  Catheter Cardiovasc Interv. 2010;  76 (4) 608-615
• 5 Webb J G, Wood D A, Ye J et al. Transcatheter valve-in-valve implantation for failed bioprosthetic heart valves.  Circulation. 2010;  121 (16) 1848-1857
• 6 Gurvitch R, Wood D A, Tay E L et al. Transcatheter aortic valve implantation: durability of clinical and hemodynamic outcomes beyond 3 years in a large patient cohort.  Circulation. 2010;  122 (13) 1319-1327
• 7 Thomas M, Schymik G, Walther T et al. One-year outcomes of cohort 1 in the Edwards SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) registry: the European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve.  Circulation. 2011;  124 (4) 425-433
• 8 Balsam L B, Grossi E A, Greenhouse D G et al. Reoperative valve surgery in the elderly: predictors of risk and long-term survival.  Ann Thorac Surg. 2010;  90 (4) 1195-1201
• 9 Maganti M, Rao V, Armstrong S, Feindel C M, Scully H E, David T E. Redo valvular surgery in elderly patients.  Ann Thorac Surg. 2009;  87 (2) 521-525
• 10 Piazza N, Bleiziffer S, Brockmann G et al. Transcatheter aortic valve implantation for failing surgical aortic bioprosthetic valve: from concept to clinical application and evaluation (part 1).  JACC Cardiovasc Interv. 2011;  4 (7) 721-732
• 11 Piazza N, Bleiziffer S, Brockmann G et al. Transcatheter aortic valve implantation for failing surgical aortic bioprosthetic valve: from concept to clinical application and evaluation (part 2).  JACC Cardiovasc Interv. 2011;  4 (7) 733-742
• 12 Smith C R, Leon M B, Mack M J et al. PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients.  N Engl J Med. 2011;  364 (23) 2187-2198