title: Image-based decision-making treatment of degenerated mitroflow and trifecta prostheses.
abstract: OBJECTIVE
  In the present report we describe our clinical experience using specific image-based decision making and anatomic considerations for transcatheter valve-in-valve (ViV) implantation in degenerated xenografts with their pericardial leaflets externally mounted around the stent (Mitroflow [SORIN Group, Milan, Italy] or Trifecta [St. Jude Medical, St Paul, MN]). This design seems to increase the risk of coronary ostia obstruction after ViV procedures.
  
  
  METHODS
  We report 5 patients with degenerated Mitroflow or Trifecta xenografts in whom different anatomic considerations led to different treatment strategies.
  
  
  RESULTS
  One patient underwent conventional redo aortic valve replacement, 2 patients underwent transcatheter ViV implantation with first-generation prostheses, and 2 patients underwent transcatheter ViV implantation using the Engager prosthesis (Medtronic, Minneapolis, MN). All patients were discharged alive in good clinical condition and were alive at 30 days after the procedure.
  
  
  CONCLUSIONS
  Transcatheter ViV procedures can be performed safely in degenerated Mitroflow and Trifecta prostheses, if the anatomy of the aortic root is taken into consideration. Precise preoperative image-based decision making is mandatory. The Engager prosthesis may allow for ViV procedures even in patients with smaller aortic roots.
authors.affiliation: Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany. Electronic address: van-linden@gmx.de.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Van Linden
authors.affiliation: Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Blumenstein
authors.affiliation: Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.affiliation: Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany; Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany.
authors.forename: Won-Keun
authors.initials: WK
authors.lastname: Kim
authors.affiliation: Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.affiliation: Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Kempfert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D001705:Bioprosthesis / Q000009:adverse effects*; D006328:Cardiac Catheterization; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*