title: Transvenous Implantation of a Stent Valve in Patients With Degenerated Mitral Prostheses and Native Mitral Stenosis.
abstract: BACKGROUND
  The purpose of this study was to report the use of a transvenous transseptal approach using a stent valve in patients with degenerated biological mitral valve prostheses, regurgitation after mitral repair, and native mitral stenosis.
  
  
  METHODS
  Ten patients (median age, 74 years; range, 20-89 years; 5 men and 5 women) with degenerated mitral bioprosthetic valves (n = 7), failed mitral repair (n = 1), or calcified native stenotic valves (n = 2) underwent transvenous implantation of a stent valve.
  
  
  RESULTS
  The procedure was initially successful in all patients. Predilation was performed for balloon sizing only in the 2 patients with native mitral stenosis. The stent valve was deployed during 1 period of rapid pacing. A guidewire, as a loop from the right femoral vein and through the left ventricular apex, facilitated a good angle and secure positioning of the stent valve. An ultrasonographically guided puncture of the apex was carried out in 6 patients, and in the other 4 we performed a minithoracotomy before apical puncture. All valves were implanted in a good position with improved function and without significant paravalvular leakage (PVL). There were no periprocedural deaths. The 30-day survival was 80% (8 of 10 patients), and 60% (6 of 10) of patients were still alive a median time of 290 days after the procedure.
  
  
  CONCLUSIONS
  Transvenous transseptal implantation of a stent valve was performed in 10 patients with mitral valve disease, with good early functional results. These high-risk patients must be carefully selected by a multidisciplinary team because the procedure carries a high mortality.
authors.affiliation: Department of Cardiothoracic Surgery, Institution of Medical and Health Sciences, Linkoping University, Linkoping, Sweden. Electronic address: henrik.casimir.ahn@liu.se.
authors.forename: Henrik Casimir
authors.initials: HC
authors.lastname: Ahn
authors.affiliation: Department of Physiology, Institution of Medical and Health Sciences, Linkoping University, Linkoping, Sweden.
authors.forename: Jacek
authors.initials: J
authors.lastname: Baranowski
authors.affiliation: Department of Cardiothoracic Surgery, Institution of Medical and Health Sciences, Linkoping University, Linkoping, Sweden.
authors.forename: Lars-Goran
authors.initials: LG
authors.lastname: Dahlin
authors.affiliation: Department of Cardiology, Institution of Medical and Health Sciences, Linkoping University, Linkoping, Sweden.
authors.forename: Niels Erik
authors.initials: NE
authors.lastname: Nielsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D002114:Calcinosis / Q000601:surgery; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D017548:Echocardiography, Transesophageal; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D005268:Femoral Vein; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D011475:Prosthesis Failure; D011667:Pulmonary Veins; D012086:Reoperation; D013908:Thoracotomy / Q000379:methods; D018084:Ultrasonography, Interventional; D055815:Young Adult