title: 5-year experience with transcatheter transapical mitral valve-in-valve implantation for bioprosthetic valve dysfunction.
abstract: OBJECTIVE
  The study sought to describe the authors' experience with mitral transapical transcatheter valve-in-valve implantation (TVIV).
  
  
  BACKGROUND
  Increasing numbers of mitral biological prostheses are being implanted in clinical practice. Transcatheter valve-in-valve implantation may be a lower risk alternative treatment for high-risk patients with mitral valve degeneration.
  
  
  METHODS
  Twenty-three consecutive patients with severe mitral bioprosthetic valve dysfunction underwent transapical mitral TVIV between July 2007 and September 2012. Bioprosthetic failure was secondary to stenosis in 6 (26.1%), regurgitation in 9 (39.1%), and combined in 8 (34.8%) patients.
  
  
  RESULTS
  All patients were elderly (mean age 81 ± 6 years) and at high-risk for conventional redo surgery (Society of Thoracic Surgeons score 12.1 ± 6.8%). Successful transapical mitral TVIV was accomplished in all patients using balloon expandable valves (Edwards Lifesciences, Irvine, California) with no intraoperative major complications. One (4.4%) major stroke and 6 (26.1%) major bleeds were reported during hospitalization. Mitral transvalvular gradient significantly decreased from 11.1 ± 4.6 mm Hg to 6.9 ± 2.2 mm Hg following the procedure (p < 0.01). Intervalvular mitral regurgitation was absent (47.8%) or mild (52.2%) in all cases after mitral TVIV. No cases of transvalvular regurgitation were seen. All patients were alive on 30-day follow-up. At a median follow-up of 753 days (interquartile range: 376 to 1,119 days) survival was 90.4%. One patient underwent successful mitral TVIV reintervention at 2 months due to atrial migration of the transcatheter valve. All patients alive were in New York Heart Association functional class I/II with good prosthetic valve performance.
  
  
  CONCLUSIONS
  Transcatheter transapical mitral valve-in-valve implantation for dysfunctional biological mitral prosthesis can be performed with minimal operative morbidity and mortality and favorable midterm clinical and hemodynamic outcomes.
authors.affiliation: St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. acheung@providencehealth.bc.ca
authors.forename: Anson
authors.initials: A
authors.lastname: Cheung
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.forename: Melanie
authors.initials: M
authors.lastname: Freeman
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Binder
authors.forename: Christopher
authors.initials: C
authors.lastname: Thompson
authors.forename: David A
authors.initials: DA
authors.lastname: Wood
authors.forename: Jian
authors.initials: J
authors.lastname: Ye
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D006328:Cardiac Catheterization; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome