Background: Transcatheter Mitral Valve-in-Valve Implantation (TMViVI) has recently emerged as a novel therapy for degenerated mitral valve bioprosthesis. Re-operative mitral valve surgery is associated with a substantial risk of mortality and morbidity. The objective of this study was to describe the outcomes of transcatheter mitral valve-in-valve implantations in our cardiac center. Methods: Twenty-two patients underwent the valve-in-valve procedure because of bioprosthesis degeneration from March 2017 to October 2018. Clinical, echocardiographic, procedural details and survival at follow up were assessed. Results: Eight patients refused re-operative cardiac surgery while others were deemed a high risk for conventional reoperative sternotomy. All patients had TMViVI performed via a trans-septal approach, and the prosthesis was implanted successfully with immediate hemodynamic improvement in 20 patients. One patient had tamponade (4.55%), two had permanent pacemaker insertion (9.09%), two patients had a renal impairment (9.09%), and three patients had vascular complications (13.64%). There was one aborted procedure for the failure to cross the tissue valve with a transcatheter valve, and one patient was converted to an emergency mitral valve surgery. All patients were discharged in NYHA class I/II and NYHA class was markedly improved at one-year follow-up (p ¼ 0.002). Conclusions: Trans-septal mitral valve-in-valve implantation can be performed safely for degenerative mitral valve bioprosthesis and with favorable early clinical and hemodynamic outcomes.

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Cardiac rehabilitation is recommended for patients with chronic heart failure (CHF) with preserved, or reduced left ventricular ejection fraction (LVEF). A cardiac rehabilitation program generally includes physical exercise, diet counseling, educational classes on lifestyle changes, and disease management as well as psychosocial support for patients and their families. Exercise training is a core component of the comprehensive cardiac rehabilitation program and is strongly recommended in combination with pharmacological treatment to patients with CHF, due to cardiorespiratory, metabolic, and autonomic cardiac response. Exercise-based cardiac rehabilitation affects positively functional capacity, exercise tolerance, and quality of life in CHF patients. The physical inactivity rate in Arabian Peninsula countries is extremely high, and exercise training of habitually physically inactive individuals should result in marked improvements of physical capacity. We present a case that demonstrates such a significant improvement in the physical capacity of a patient with CHF and a review of literature.

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