Transapical Transcatheter Mitral Valve Implantation in Patients with a History of Surgical Mitral Valve Procedures

Background: Redo mitral valve surgery is a standard of care in patients presenting with degenerated bioprosthetic mitral valve or failed annuloplasty. As surgical redo procedure might be required in up to 35% of patients with a history of MV surgery, we aimed to evaluate our outcomes after transapical transcatheter mitral valve replacement in patients with degenerated mitral bioprostheses or failed mitral ring annuloplasty and high or prohibitive surgical risk for redo mitral valve replacement.

Method: We retrospectively analyzed the patients’ data, who between August 2012 and December 2020 underwent transcatheter mitral “valve-in-valve” (n = 25) or “valve-in-ring” (n = 16) implantation at our center.

Results: Mean logistic EuroSCORE I was 42.3 ± 20.5%, STS score was 11.9 ± 10.8%, and STS/ACC score was 7.6 ± 4.2%. The procedure was successful in all patients (100%). Early postoperative echocardiographic examinations showed no obstruction of the left ventricular outflow tract and no paravalvular leakage. All patients survived the procedure. We observed a 30-day mortality of 9.8%. Survival was 72% at 1 year and 63% at 3 years. At 2-year follow-up, transvalvular mean pressure gradients were 4.6 ± 1.4 mm Hg.

Conclusion: Transapical transcatheter mitral valve-in-valve or valve-in-ring implantation presents a feasible, true minimally invasive alternative to surgical redo procedures, especially in high-risk patients with a history of conventional mitral surgery.

Publication History

Article published online:
03 February 2022