title: Transcatheter valve-in-ring implantation after failure of surgical mitral repair.
abstract: OBJECTIVE
  Redo surgery after failed mitral valve repair may be high risk, or contraindicated in patients with comorbidities. Because of this high risk, other interventional possibilities like transcatheter valve implantation might be of benefit. We report our experience with transcatheter mitral valve-in-ring implantation (TVIR) in high-risk patients after failure of surgical ring annuloplasty.
  
  
  METHODS
  From January 2010 to February 2012, following a multidisciplinary discussion, 17 high-risk patients underwent TVIR using Edwards SAPIEN XT prostheses, via either a transvenous transseptal (n = 8), or a transapical approach (n = 9).
  
  
  RESULTS
  Patients were aged 70 ± 16 years, in New York Association classes III/IV. Their mean logistic EuroSCORE was 36 ± 17% and mean Society of Thoracic Surgeons risk score 13 ± 9%. The mean time interval between surgery and repair failure was 7 ± 3 years. Annuloplasty rings were semi-rigid in 14 cases, flexible in 2, and rigid in 1. Manufacturers ring diameters were 26 mm in 4 patients, 27 mm in 1, 28 mm in 9, 30 mm, 31 mm and 34 mm in 1. The predominant failure mode was regurgitation in 12 cases and stenosis in 5. SAPIEN XT diameters were 26 mm in 15 patients, 23 mm and 29 mm in 1. Procedural success rate was 88% (15/17). Emergency surgery was needed in 1 patient due to acute dislodgement of the ring. The degree of mitral regurgitation was reduced to none or mild in all but 2 patients; final mean gradient was 7 ± 3 mmHg. Thirty-day survival was 82% (14/17 patients). At last follow-up (13 ± 5 months), survival rate was 71% (12/17).
  
  
  CONCLUSIONS
  These preliminary results suggest that TVIR is feasible, with low operative risk, and may provide short-term clinical and haemodynamic improvement in selected high-risk patients with failure of mitral ring annuloplasty.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.
authors.forename: Fleur
authors.initials: F
authors.lastname: Descoutures
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Filip
authors.initials: F
authors.lastname: Casselman
authors.forename: Arend
authors.initials: A
authors.lastname: de Weger
authors.forename: Oana
authors.initials: O
authors.lastname: Bodea
authors.forename: Frank
authors.initials: F
authors.lastname: Van der Kley
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Cristina
authors.initials: C
authors.lastname: Giannini
authors.forename: Kjell Arne
authors.initials: KA
authors.lastname: Rein
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Gry
authors.initials: G
authors.lastname: Dahle
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects*; D017211:Treatment Failure
keywords: High risk; Mitral repair; Transapical; Transseptal; Valve-in-ring implantation