Delayed migration of sapien valve following a transcatheter mitral valve-in-valve implantation


  • Vinayak (Vinnie) Nilkanth Bapat FRCS.CTh,

    Corresponding author
    1. Department of Cardiothoracic surgery, St Thomas' hospital, London, United Kingdom
    • Correspondence to: Vinayak (Vinnie) Nilkanth Bapat, Department of Cardiothoracic Surgery, 6th Floor, East wing, St Thomas' hospital, Westminster bridge road, London SE1 7EH, United Kingdom. E-mail:

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  • Feras Khaliel MD,

    1. Department of Cardiothroacic surgery and Cardiology, King Faisal specialist hospital, Riyadh, Saudi Arabia
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  • Leo Ihleberg MD

    1. Department of Cardiac surgery and Cardiology, Helsinki University hospital, Helsinki, Finland
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  • Conflict of interest: Mr. Vinnie Bapat—Consultant for Edwards Lifesciences, Medtronic Inc, St. Jude Medical, Symetis. Dr. Leo Ihlberg—Consultant for Edwards Lifesciences


We report two cases of delayed migration of the Sapien XT device after a successful mitral valve-in-valve (VIV) implantation. The procedure was performed through a transapical approach. Echocardiography was used to choose the size of the Sapien XT device. Although the immediate results were satisfactory both the cases presented with severe regurgitation (1 week and 3 months). Investigations revealed atrial migration of the Sapien device in both the cases, which was confirmed at the time of reoperation. We discuss possible mechanisms, which could have resulted in the delayed migration and highlight the difference between VIV procedures in mitral position versus other positions. © 2013 Wiley Periodicals, Inc.