title: Treatment of Aortic, Mitral and Tricuspid Structural Bioprosthetic Valve Deterioration Using the Valve-in-Valve Technique.
abstract: OBJECTIVE
  The percutaneous approach for a failed bioprosthetic valve is an emerging alternative to redo-valve surgery in patients at high surgical risk. The study aim was to describe the treatment of patients with structural bioprosthetic valve deterioration, using the valve-in-valve technique.
  
  
  METHODS
  A total of 33 consecutive patients with symptomatic structural bioprosthetic valve deterioration was treated at the authors' institution, using the valve-in-valve technique.
  
  
  RESULTS
  The valve-in-valve procedure in the aortic position was performed in 23 patients (mean age 81.4 ± 5.9 years; mean STS score 9.6 ± 5.4). The self-expandable and balloon-expandable devices were used in 21 cases (91.3%) and two cases (8.7%), respectively. Procedures were performed via the trans-femoral, trans-axillary and trans-apical routes in 18 (78.2%), three (13%) and two (8.7%) cases, respectively. After the procedure, all patients were in NYHA class I/II. Survival rates were 95.6% at the one-year follow up. The valve-in-valve procedure in the mitral position was performed in 10 patients (mean age 73.6 ± 15 years; mean STS score 7.7 ± 4.1). All procedures were performed using the balloon-expandable device via the trans-apical route. The composite end point of device success was achieved in all patients. Survival rates were 100% and 75% at one month and two years' follow up, respectively. A single valve-in-valve implantation within a failed tricuspid bioprosthetic valve was also successfully performed.
  
  
  CONCLUSIONS
  In the authors' experience, the valve-in-valve technique for the treatment of a wide range of bioprosthetic valve deterioration modes of failure in different valve positions is safe and very effective.
authors.forename: Pablo
authors.initials: P
authors.lastname: Codner
authors.forename: Abid
authors.initials: A
authors.lastname: Assali
authors.forename: Hana
authors.initials: H
authors.lastname: Vaknin-Assa
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shapira
authors.forename: Katia
authors.initials: K
authors.lastname: Orvin
authors.forename: Ram
authors.initials: R
authors.lastname: Sharony
authors.forename: Alexander
authors.initials: A
authors.lastname: Sagie
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D063126:Balloon Valvuloplasty; D001705:Bioprosthesis / Q000009:adverse effects*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D012086:Reoperation