title: Transapical Transcatheter Valve-in-Valve Implantation for Failed Mitral Valve Bioprosthesis.
abstract: Background: The rate of mitral bioprosthesis implantation in clinical practice is increasing. Transcatheter valve-in- valve implantation has been described for high risk patients requiring redo valve surgery.
  
  
  OBJECTIVE
  To report our experience with transapical valve-in-valve implantation for failed mitral bioprosthesis.
  
  
  METHODS
  Since 2010, 10 patients have undergone transapical valve-in-valve implantation for failed bioprosthesis in our center. Aortic valve-in-valve implantation was performed in one of them and mitral valve-in-valve implantation in nine. Mean age was 82 ± 4 years and 6 were female (67%). Mean time from original mitral valve (MV) replacement to valve-in-valve procedure was 10.5 ± 3.7 years. Follow-up was completed by all patients with a mean duration of 13 ± 12 months.
  
  
  RESULTS
  Preoperatively, all patients presented with significant mitral regurgitation, two with mitral stenosis due to structural valve failure. All nine patients underwent successful transapical valve-in-valve implantation with an Edwards Sapien balloon expandable valve. There was no in-hospital mortality. Mean and median hospital duration was 15 ± 18 and 7 days respectively. Valve implantation was successful in all patients and there were no major complications, except for major femoral access bleeding in one patient. At last follow-up, all patients were alive and in NYHA functional class I or II. Echocardiography follow-up demonstrated that mitral regurgitation was absent or trivial in seven patients and mild in two. At follow-up, peak and mean gradients changed from 26 ± 4 and 8 ± 2 at baseline to 16.7 ± 3 and 7.3 ± 1.5, respectively.
  
  
  CONCLUSIONS
  Transcatheter transapical mitral valve-in-valve implantation for failed bioprosthesis is feasible in selected high risk patients. Our early experience with this strategy is encouraging. Larger randomized trials with long-term clinical and echocardiographic follow-up are recommended.
authors.forename: Eyal R
authors.initials: ER
authors.lastname: Nachum
authors.forename: Ehud
authors.initials: E
authors.lastname: Raanani
authors.forename: Amit
authors.initials: A
authors.lastname: Segev
authors.forename: Victor
authors.initials: V
authors.lastname: Guetta
authors.forename: Ilan
authors.initials: I
authors.lastname: Hai
authors.forename: Amihai
authors.initials: A
authors.lastname: Shinfeld
authors.forename: Paul
authors.initials: P
authors.lastname: Fefer
authors.forename: Hamdan
authors.initials: H
authors.lastname: Ashraf
authors.forename: Israel
authors.initials: I
authors.lastname: Barabash
authors.forename: Amjad
authors.initials: A
authors.lastname: Shalabi
authors.forename: Dan
authors.initials: D
authors.lastname: Spiegelstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000601:surgery*; D011475:Prosthesis Failure