title: Transcatheter access route options for treatment of degenerated mitral valve prosthesis with a balloon-expandable biological valve.
abstract: OBJECTIVE
  There is an ongoing discussion if valve-in-valve implantations into failing mitral xenografts should be performed only via a transapical approach.
  
  
  BACKGROUND
  In selected high-risk patients, transcatheter valve implantation is an emerging therapy for degenerated mitral xenografts in need of repeated valve replacement.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Feasibility of all three approaches is demonstrated and might be taken into consideration for treatment in various patients.
authors.affiliation: Division of Cardiology, AK St. Georg Hospital, Hamburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schaefer
authors.forename: Christian
authors.initials: C
authors.lastname: Frerker
authors.forename: Ralf
authors.initials: R
authors.lastname: Bader
authors.forename: Michael
authors.initials: M
authors.lastname: Schmoeckel
authors.forename: Cord
authors.initials: C
authors.lastname: Busse
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D000369:Aged, 80 and over; D063126:Balloon Valvuloplasty; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016896:Treatment Outcome