title: Percutaneous complete repair of failed mitral valve prosthesis: simultaneous closure of mitral paravalvular leaks and transcatheter mitral valve implantation - single-centre experience.
abstract: OBJECTIVE
  Structural deterioration and paravalvular leak (PVL) are complications associated with surgically implanted prosthetic valves, historically requiring reoperation. We present our experience of complete transcatheter repair of a degenerated mitral bioprosthesis.
  
  
  RESULTS
  From March 2012 to October 2012, we reviewed consecutive, high-risk surgical patients (n=5) who underwent transcatheter repair of a failed mitral bioprosthesis with severe paravalvular regurgitation (PVR). Manufacturer valve sizes ranged from 27 to 33 mm, regurgitation (n=1), stenosis (n=1), or both (n=3). Percutaneous transapical and transseptal access were achieved with PVL closure performed transapically. An arteriovenous rail was created for transseptal delivery of a Melody valve. All patients had successful PVL closure with no residual PVR. Valve-in-valve (ViV) implantation was successful in four patients. Overall, mean transvalvular mitral gradient was 11.2 mmHg pre-procedure which improved to 5 mmHg post-procedure. Improvement of NYHA Class ≥2 was achieved in all patients (19±3 months). One patient had controlled Melody valve embolisation which required emergent surgical replacement. Inner valve diameter was 26 mm, too large for Melody valve implantation.
  
  
  CONCLUSIONS
  Complete transcatheter repair of a degenerated mitral bioprosthesis with PVR can be performed in the high-risk patient. Accurate measurement is necessary prior to intervention, with concern for embolisation among the larger valve sizes (>31 mm).
authors.affiliation: Lenox Hill Heart and Vascular Institute - North Shore/LIJ Health System, New York, NY, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Kliger
authors.forename: Rocio
authors.initials: R
authors.lastname: Angulo
authors.forename: Leandro
authors.initials: L
authors.lastname: Maranan
authors.forename: Robert
authors.initials: R
authors.lastname: Kumar
authors.forename: Vladimir
authors.initials: V
authors.lastname: Jelnin
authors.forename: Itzhak
authors.initials: I
authors.lastname: Kronzon
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Fontana
authors.forename: Konstadinos
authors.initials: K
authors.lastname: Plestis
authors.forename: Nirav
authors.initials: N
authors.lastname: Patel
authors.forename: Gila
authors.initials: G
authors.lastname: Perk
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Ruiz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D011475:Prosthesis Failure / Q000009:adverse effects*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome