Transcatheter valve-in-valve implantation for failed bioprosthetic heart valves.
BACKGROUND
The majority of prosthetic heart valves currently implanted are tissue valves that can be expected to degenerate with time and eventually fail. Repeat cardiac surgery to replace these valves is associated with significant morbidity and mortality. Transcatheter heart valve implantation within a failed bioprosthesis, a "valve-in-valve" procedure, may offer a less invasive alternative.


RESULTS
Valve-in-valve implantations were performed in 24 high-risk patients. Failed valves were aortic (n=10), mitral (n=7), pulmonary (n=6), or tricuspid (n=1) bioprostheses. Implantation was successful with immediate restoration of satisfactory valve function in all but 1 patient. No patient had more than mild regurgitation after implantation. No patients died during the procedure. Thirty-day mortality was 4.2%. Mortality was related primarily to learning-curve issues early in this high-risk experience. At baseline, 88% of patients were in New York Heart Association functional class III or IV; at the last follow-up, 88% of patients were in class I or II. At a median follow-up of 135 days (interquartile range, 46 to 254 days) and a maximum follow-up of 1045 days, 91.7% of patients remained alive with satisfactory valve function.


CONCLUSIONS
Transcatheter valve-in-valve implantation is a reproducible option for the management of bioprosthetic valve failure. Aortic, pulmonary, mitral, and tricuspid tissue valves were amenable to this approach. This finding may have important implications with regard to valve replacement in high-risk patients.
Webb
John G
JG
St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, Canada. john.webb@vch.ca
Wood
David A
DA
Ye
Jian
J
Gurvitch
Ronen
R
Masson
Jean-Bernard
JB
Rodés-Cabau
Josep
J
Osten
Mark
M
Horlick
Eric
E
Wendler
O
O
Dumont
Eric
E
Carere
Ronald G
RG
Wijesinghe
Namal
N
Nietlispach
Fabian
F
Johnson
Mark
M
Thompson
Chrisopher R
CR
Moss
Robert
R
Leipsic
Jonathon
J
Munt
Brad
B
Lichtenstein
Samuel V
SV
Cheung
Anson
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011665:Pulmonary Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D012086:Reoperation / Q000401:mortality; D012307:Risk Factors; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery