title: Mitral valve-in-valve and valve-in-ring for failing surgical bioprosthetic valves and rings.
abstract: The transcatheter valve-in-valve (VIV) procedure for failed aortic bioprostheses is recognized as an alternative treatment to conventional surgery in high-risk patients. This less invasive option has now been applied to failed mitral bioprostheses (VIV) or failed repairs i.e. valve-in-ring (VIR). In this emerging field, to get an optimal result, a good understanding of the design features of the failed surgical heart valve/ring, the transcatheter heart valve being used and their compatibility, is of paramount importance. Although similar in many ways to the aortic counterpart, a mitral VIV/VIR procedure can pose certain different challenges such as delayed migration and left ventricular outflow tract obstruction. This review describes the features of bioprostheses, rings and THVs relevant to a VIV/VIR procedure, and also provides guidance regarding sizing, positioning and how to avoid some of the major complications therefore improving the chances of a successful outcome.
authors.affiliation: Department of Cardiothoracic Surgery, St. Thomas' Hospital, London, UK - vnbapat@yahoo.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Ghosh-Dastidar
authors.forename: Ashok
authors.initials: A
authors.lastname: Narayana
authors.forename: Ricardo
authors.initials: R
authors.lastname: Boix
authors.forename: Vinayak
authors.initials: V
authors.lastname: Bapat
mesh_terms: D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000379:methods*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation