title: Balloon-expandable valves for degenerated mitral xenografts or failing surgical rings.
abstract: OBJECTIVE
  Transcatheter mitral valve-in-valve implantation (TMViVI) for the treatment of failing mitral xenografts or recurrent mitral regurgitation after surgical ring implantation is an emerging therapy for patients in need of repeated mitral valve surgery. Despite the fact that these procedures have been shown to be feasible and effective, haemodynamic data after TMViVI are still limited in the literature.
  
  
  RESULTS
  Twelve patients (logES: 39.2±23.5%) were treated either by transapical (n=7) or transseptal (n=5) TMViVI, as a valve-in-valve (ViV, n=8) or valve-in-ring (ViR, n=4) implantation. Left atrial pressures (LAP), transmitral gradients and right heart haemodynamics (Swan-Ganz catheterisation) were studied before and after TMViVI. Procedural success was 100%, mitral regurgitation after TMViVI was mild in one, trace in five and absent in six patients. Thirty-day mortality was 0%. Left atrial pressures decreased significantly after valve implantation (before LAPmean/v-wave: 24.3/44.1 mmHg; after LAP/v-wave 15.9/22.1 mmHg; p<0.001) and cardiac output increased significantly. Transmitral gradients corresponded to mitral surface areas between 1.7 and 3.5 cm2, and were thus very acceptable in terms of the high surgical risk population.
  
  
  CONCLUSIONS
  In conclusion, TMViVI with the balloon-expandable SAPIEN XT valve for ViV or ViR implantation is feasible with promising acute transmitral haemodynamic data. Nevertheless, sustained long-term performance remains to be demonstrated in the future.
authors: Division of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors: Ulrich
authors: U
authors: Schäfer
authors: Ralf
authors: R
authors: Bader
authors: Christian
authors: C
authors: Frerker
authors: Dimitry
authors: D
authors: Schewel
authors: Thomas
authors: T
authors: Thielsen
authors: Michael
authors: M
authors: Schmoeckel
authors: Felix
authors: F
authors: Kreidel
authors: Karl-Heinz
authors: KH
authors: Kuck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016279:Atrial Function, Left; D062185:Atrial Pressure; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation*; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D064593:Heterografts; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000295:instrumentation*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011475:Prosthesis Failure; D015641:Radiography, Interventional; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome