title: Transcatheter valve in valve implantation for failed mitral and tricuspid bioprosthesis.
abstract: OBJECTIVE
  We report our experience with the transapical transcatheter "Valve in valve" implantation (T-VIV) in patients with a failed mitral or tricuspid bioprosthesis; we briefly review the pertinent literature, and discuss some technical aspects of this procedure.
  
  
  BACKGROUND
  Redo valve surgery for failure of a mitral or tricuspid bioprosthesis might become extremely challenging, both because of the patients' condition, which is frequently poor, and for the technical aspects of the operation itself, that can be very demanding. T-VIV has been widely employed with good results for the treatment of aortic bioprosthesis failure, and could represent an attractive option in this setting.
  
  
  METHODS
  Four patients with multiple comorbidities (age: 63-83 years; logistic Euroscore: 37.2-81.5) underwent T-VIV at our institution for failure of a mitral [3] or tricuspid [1] bioprosthesis. A 26 mm Sapien valve was used in all cases. All the mitral procedures were performed via a transapical approach. The tricuspid procedure was performed via a transjugular approach.
  
  
  RESULTS
  The first mitral procedure was complicated by the splaying of the xenograft stents and embolization of the valve. The procedure was converted to conventional surgery, and the patient died on postoperative day 1. In the subsequent procedures, the valve was positioned more atrially, and was fixed to the malfunctioning xenograft sewing ring. All subsequent procedures were successful, all patients were discharged home and were alive and well at follow-up.
  
  
  CONCLUSIONS
  The results of T-VIV procedure in the mitral position have been suboptimal, and four of the sixteen patients reported to date died. However, all patients were extremely diseased, and some of the reported failures were related to amendable technical factors relative to the surgical access or to the valve deployment technique. With increasing experience, this procedure might become indicated as an alternative to conventional surgery in selected patients, encouraging increased use of bioprosthesis, and marking a pivotal change in the management of valvular disease.
authors.affiliation: Operative Unit of Cardiac Surgery, G. Pasquinucci Hospital, G. Monasterio Foundation, Massa, Italy. acerillo@yahoo.com
authors.forename: Alfredo Giuseppe
authors.initials: AG
authors.lastname: Cerillo
authors.forename: Francesca
authors.initials: F
authors.lastname: Chiaramonti
authors.forename: Michele
authors.initials: M
authors.lastname: Murzi
authors.forename: Stefano
authors.initials: S
authors.lastname: Bevilacqua
authors.forename: Elisa
authors.initials: E
authors.lastname: Cerone
authors.forename: Cataldo
authors.initials: C
authors.lastname: Palmieri
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Sarto
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mariani
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015641:Radiography, Interventional; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*