Simultaneous transapical aortic and mitral valve‐in‐valve implantation for double prostheses dysfunction: Case report and technical insights

Abstract

Transcatheter "Valve-in-Valve" implantation (ViV) has shown promising results in high-risk patients suffering from structural valve deterioration (SVD) of a previously implanted heart valve bioprosthesis. We present a case of a 68-year-old woman with a history of three previous cardiac operations on the aortic and mitral valve. At the time of admission she was severely symptomatic due to a simultaneous SVD of a 23 mm aortic and of a 29 mm mitral St. Jude Biocor bioprosthesis. Because of the history of several cardiac operations and to her comorbidities, the patient was considered with an extremely high surgical risk profile and was therefore scheduled for double concomitant mitral and aortic ViV. Through a trans-apical approach, the patient underwent 23 and 29 mm Edwards Sapien XT implantation in the aortic and mitral bioprosthesis, respectively. The procedure was uneventful as well as the following hospital stay. At 6-months follow-up the patient is in NYHA class I. Echocardiography shows that the aortic bioprosthesis has no leak and the mean gradient is 20 mm Hg while the mitral valve has mild leak and maximum and mean gradients are 21 and 10 mm Hg, respectively. The three main technical aspects that should be carefully considered in double concomitant ViV are: sequence of valve deployment (whether to implant the mitral or the aortic valve first), choice of access and valve sizing. In conclusion, double simultaneous trans-apical mitral and aortic ViV is technically feasible. © 2014 Wiley Periodicals, Inc.

Transcatheter mitral valve implantation for degenerated mitral bioprostheses or failed surgical annuloplasty rings: A systematic review and meta-analysis

“…From 2009 to March 31, 2018, 66 published reports describing 172 patients undergoing TMVIV implantation for degenerated mitral bioprostheses and 35 articles describing 73 patients undergoing TMVIR implantation for failed annuloplasty rings were identified (Figure ). The patients were diagnosed with MR, MS, or mixed lesions according to the articles but the failure modes of 34 patients were unknown.…”

Early and Midterm Clinical and Hemodynamic Outcomes of Transcatheter Valve-in-Valve Implantation: Results From a Multicenter Experience

“…VIV was born as an alternative to standard reintervention with the goal to reduce the invasiveness of the procedure and to offer a therapeutic option to highrisk and inoperable patients. VIV-M and VIV-A have been already described in inoperable and high-risk patients [14]. The approach is still not standardized and different types of transcatheter devices for different degenerated bioprostheses have been used [15].…”

A systematic review of reported cases of combined transcatheter aortic and mitral valve interventions

“…A total of 1783 articles were screened and total of 37 studies met our inclusion/exclusion criteria. The details of study selection are summarized in Figure .…”