Bioprosthesis replacement with mechanical valve implantation on the bioprosthetic ring Surgical and 2D echo considerations

Abstract

Removal of a failing bioprosthesis can be a delicate operation and extensive damage can be caused. Eighteen patients with failing bioprostheses underwent excision of the leaflets, then the "new" mechanical valve was sewn onto the "old" bioprosthetic ring. At follow-up, clinical and 2D color-flow echo-Doppler evaluations showed good hemodynamic performance of the mechanical valves.

Transcatheter valve in valve implantation for failed mitral and tricuspid bioprosthesis

“…The removal of a failing mitral or tricuspid bioprosthesis might become challenging, and carries the risk of extensive damage to the myocardium and to the atrioventricular junction [3–5]. Consequentially, the transcatheter valve in valve procedure may represent an attractive option in this setting, particularly in severely diseased patients with multiple comorbidities and with fragile cardiac structures.…”

“…Because of their extreme intrinsic frailty, these 13 patients were not the best candidates for the procedure, and four of them did not survive. In our opinion, since redo mitral and tricuspid valve replacement may expose even the perfect patient to a significant risk of mechanical complications [5], this option should be considered in patients older than 70 years, when the preoperative assessment suggests a high probability for a difficult removal of the malfunctioning xenograft (evident calcifications, more than one previous operation, fragile tissues), even when the calculated logistic Euroscore is <20%.…”

“…Redo valve surgery for bioprosthetic valve failure may be a hard challenge, both because of the patients' clinical condition, that is frequently poor [3, 4], and for the technical aspects of the operation itself, that can be very demanding [5]. In fact, mitral and tricuspid bioprostheses are extensively covered by neoendocardium, and their struts are deeply embedded into the ventricular wall.…”

“…In these cases, the removal of a mitral and/or tricuspid bioprosthesis becomes difficult, and sometimes irreparable damage can occur. Furthermore the remaining annulus can be very weak and perivalvular leaks may ensue [5].…”

Innovative, Replaceable Heart Valve: Concept, In Vitro Study, and Acute In Vivo Study

“…Implantation of a mechanical valve within (valve‐in‐valve) or above (valve‐on‐valve) the sewing ring of the bioprosthetic valve after excision of the valve's leaflets has also been reported (8,9). Implantation of a bioprosthetic valve above the sewing ring has also been performed (10).…”