Transcatheter access route options for treatment of degenerated mitral valve prosthesis with a balloon-expandable biological valve


  • Conflict of interest: The corresponding author Ulrich Schäfer and the senior author Karl-Heinz Kuck are consultants to Edwards Lifesciences Inc. and Medtronic Inc. and Ulrich Schäfer is a proctor for both companies, respectively. The remaining authors report no conflicts of Interest Disclosures.



There is an ongoing discussion if valve-in-valve implantations into failing mitral xenografts should be performed only via a transapical approach.


In selected high-risk patients, transcatheter valve implantation is an emerging therapy for degenerated mitral xenografts in need of repeated valve replacement.


Here we describe three different strategies to treat a failing mitral biological prosthesis (Carpentier Edwards S.A.V) by implantation of a SAPIEN-XT valve, which was performed in three different patients. As access site, a transjugular/transseptal approach, a transfemoral/transseptal approach, and a transapical approach were chosen.


With all three approaches, valve-in-valve implantation was successfully achieved. The acute hemodynamic effects were excellent and according to VARC there was no adverse event recorded during a 6 months follow-up.


Feasibility of all three approaches is demonstrated and might be taken into consideration for treatment in various patients. © 2012 Wiley Periodicals, Inc.