Conflict of interest: The authors have no conflicts of interest to disclose.
Valvular and Structural Heart Diseases
Series of transcatheter valve-in-valve implantations in high-risk patients with degenerated bioprostheses in aortic and mitral position†
Article first published online: 30 APR 2010
Copyright © 2010 Wiley-Liss, Inc.
Catheterization and Cardiovascular Interventions
Volume 76, Issue 4, pages 608–615, 1 October 2010
How to Cite
Seiffert, M., Franzen, O., Conradi, L., Baldus, S., Schirmer, J., Meinertz, T., Reichenspurner, H. and Treede, H. (2010), Series of transcatheter valve-in-valve implantations in high-risk patients with degenerated bioprostheses in aortic and mitral position. Cathet. Cardiovasc. Intervent., 76: 608–615. doi: 10.1002/ccd.22618
- Issue published online: 30 APR 2010
- Article first published online: 30 APR 2010
- Manuscript Accepted: 19 APR 2010
- Manuscript Received: 9 MAR 2010
- reoperative valve replacement;
- xenograft degeneration
Objectives: We report our experience with transcatheter valve-in-valve implantations in patients with degenerated bioprostheses in aortic and mitral position. Background: Xenograft degeneration is a potential problem after biological valve replacement. Reoperation remains the gold standard with very good short- and long-term results. In selected patients not suitable for surgery however, interventional techniques for valve implantation and repair may be valuable alternative treatment options with regard to the good results of transcatheter valve implantation for native aortic valve stenosis. Methods: Five patients presented with significant xenograft degeneration 15.4 ± 5.2 years after aortic (n = 4) and mitral (n = 1) valve replacement. Mean patient age was 82.0 ± 6.5 years and predicted operative mortality was 55.8% ± 18.9% (logistic EuroSCORE). Transcatheter valve-in-valve implantation was performed successfully through a transapical access in all patients. A 23-mm Edwards Sapien valve was deployed into the degenerated valve prosthesis. Results: Mean transvalvular gradients were reduced from 31.2 ± 17.4 to 19.0 ± 12.4 mm Hg in aortic and from 9 to 3 mm Hg in mitral position without significant regurgitation in any of these patients. Two patients died within 30 days due to low cardiac output and acute hemorrhage, respectively, one of whom presented with a EuroSCORE of 88.9%. Conclusions: With growing need for reoperative valve replacement in elderly patients with disproportional operative risks, transcatheter valve-in-valve implantation in aortic and mitral position offers an alternative treatment option. Although valve function after transcatheter implantation was good in all patients, two high risk patients died in the postoperative period due to their significant comorbidities, underscoring the bail-out character of this procedure. © 2010 Wiley-Liss, Inc.