title: Percutaneous mitral valve replacement using a transvenous, transseptal approach: transvenous mitral valve replacement.
abstract: OBJECTIVE
  The aim of this paper is to describe the feasibility of a novel transcatheter approach for mitral valve replacement using only venous access.
  
  
  BACKGROUND
  Failure of mitral valve prostheses necessitating reoperation can represent a high-risk clinical scenario. Although repeat cardiac surgery remains the standard of care for most failed mitral valve operations, nascent transcatheter options are under development for patients at high or extremely risk of surgery. Most often, this is performed via a transapical approach in the operating room, with associated risk of complications as well as extended length of hospital stay.
  
  
  METHODS
  We describe a case series of 4 consecutive patients at high risk of reoperation with degenerative mitral prostheses (bioprosthetic valves or rings) who successfully underwent transvenous, transseptal mitral valve replacement with a commercially available transcatheter heart valve.
  
  
  RESULTS
  From April to May 2014, 4 consecutive patients underwent transvenous, transseptal mitral valve replacement with a transcatheter heart valve. The mean age was 72 ± 9.9 years, and the average Society of Thoracic Surgeons risk score was 12.5 ± 7.2%. All patients had severe, life-limiting dyspnea. The 4 procedures were successful without intra- or post-procedural complications; echocardiography indicated a well-seated and functioning mitral valve-in-valve or valve-in-ring. Patients were discharged within 2 days after valve replacement with marked improvement in dyspnea.
  
  
  CONCLUSIONS
  We describe an innovative technique of transcatheter mitral valve replacement. This case series demonstrates the feasibility of transcatheter mitral valve replacement using only femoral venous access, with a marked reduction in complications and length of hospital stay compared with transapical access or redo surgery.
authors.affiliation: Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Megan
authors.initials: M
authors.lastname: Coylewright
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Allison K
authors.initials: AK
authors.lastname: Cabalka
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Malouf
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Geske
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Pollak
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: rihal@mayo.edu.
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: degenerative mitral prosthesis; percutaneous mitral intervention; percutaneous mitral repair; transcatheter mitral valve replacement; transcatheter valve-in-ring procedure; transcatheter valve-in-valve procedure