title: Transcatheter valve-in-ring implantation of a repositionable valve system for treatment of severe mitral regurgitation.
abstract: BACKGROUND
  Years after mitral valve surgery, progressive degeneration of reconstructed mitral valves or bioprostheses might lead to severe mitral valve regurgitation. Patients with significant comorbidity, or impaired left ventricular function are poor candidates for redo surgery at an acceptable risk at that later time point.
  
  
  RESULTS
  This study reports the first-in-man transapical valve-in-ring implantations in the mitral position of the fully repositionable Lotus valve system approved for transcatheter aortic valve replacement in Europe. Transapical valve-in-ring implantations with this valve system were successfully performed in a 64-year-old female, and a 53-year-old male patient. Both patients were NHYA class IV, and carried an unacceptably high risk of cardiac surgery due to clinical condition and comorbidity. The first patient was successfully implanted a 25 mm valve, improved to NYHA class II, and was discharged 2 weeks after the procedure. The second patient required a short episode of cardiopulmonary resuscitation after valve implantation (27 mm), and was placed on veno-venous ECMO for 24 hr to improve oxygenation. He developed stroke on day 7, and deceased from fatal, toxic rhabdomyolysis 13 days after the procedure.
  
  
  CONCLUSIONS
  Transapical valve-in-ring implantation of the repositionable Lotus valve system in the mitral position is a feasible and promising option that merits further evaluation. © 2015 Wiley Periodicals, Inc.
authors.affiliation: 3rd Medical Clinic - Cardiology, Krankenhaus Der Barmherzigen Brüder Trier, Nordallee 1, 54296 Trier, Germany, a Teaching Affiliate of the University Medical Center Mainz, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Lauterbach
authors.affiliation: 3rd Medical Clinic - Cardiology, Krankenhaus Der Barmherzigen Brüder Trier, Nordallee 1, 54296 Trier, Germany, a Teaching Affiliate of the University Medical Center Mainz, Germany.
authors.forename: Bruno
authors.initials: B
authors.lastname: Sontag
authors.affiliation: Department of Heart, Vascular and Thoracic Surgery, Krankenhaus Der Barmherzigen Brüder Trier, Nordallee 1, 54296 Trier, Germany, a Teaching Affiliate of the University Medical Center Mainz, Germany.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Paraforos
authors.affiliation: Department of Heart, Vascular and Thoracic Surgery, Krankenhaus Der Barmherzigen Brüder Trier, Nordallee 1, 54296 Trier, Germany, a Teaching Affiliate of the University Medical Center Mainz, Germany.
authors.forename: Ivar
authors.initials: I
authors.lastname: Friedrich
authors.affiliation: 3rd Medical Clinic - Cardiology, Krankenhaus Der Barmherzigen Brüder Trier, Nordallee 1, 54296 Trier, Germany, a Teaching Affiliate of the University Medical Center Mainz, Germany.
authors.forename: Karl-Eugen
authors.initials: KE
authors.lastname: Hauptmann
mesh_terms: D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*; D011474:Prosthesis Design
keywords: heart failure; low output; mitral valve reconstruction; nitinol; repositionable