title: Transcatheter implantation of aortic valve prostheses into degenerated mitral valve bioprostheses and failed annuloplasty rings: outcomes according to access route and Mitral Valve Academic Research Consortium (MVARC) criteria.
abstract: OBJECTIVE
  The study sought to assess outcomes of transcatheter mitral valve-in-valve implantation (TMVIV) for degenerated bioprostheses and transcatheter mitral valve-in-ring implantation (TMVIR) for failed annuloplasty rings according to access route and the Mitral Valve Academic Research Consortium (MVARC) criteria.
  
  
  RESULTS
  Twenty-four patients (72±13 years; eight men [33%]) underwent TMVIV (n=14) or TMVIR (n=10) for mitral regurgitation (MR; n=17) or stenosis (n=7) using balloon-expandable bioprostheses. Transapical (TA) access was chosen in 13, and transseptal (TS) access in 11 patients. MVARC technical success, device success and procedural success were 95.8%, 41.7% and 33.3%, respectively, with no differences between access routes. Cardiac output (CO) increased significantly by 1.1±0.8 l/min in TS patients, but not in TA patients (ΔCO=0.0±0.5 l/min; p=0.0051). Overall three-year survival was estimated at 57.6% (95% confidence interval: 33.9-81.3; TA 35.5% [5.2-65.9]; TS 90.9% [73.9-100]). Survival up to four years according to vascular access showed a clear benefit in patients treated transseptally (p=0.045).
  
  
  CONCLUSIONS
  Regardless of the access route, TMVIV/TMVIR was associated with high technical success yet impaired device success. In the long term, TA access had a significant adverse impact on survival.
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Frerker
authors.forename: Tobias
authors.initials: T
authors.lastname: Schmidt
authors.forename: Michael
authors.initials: M
authors.lastname: Schlüter
authors.forename: Ralf
authors.initials: R
authors.lastname: Bader
authors.forename: Jury
authors.initials: J
authors.lastname: Schewel
authors.forename: Dimitry
authors.initials: D
authors.lastname: Schewel
authors.forename: Thomas
authors.initials: T
authors.lastname: Thielsen
authors.forename: Felix
authors.initials: F
authors.lastname: Kreidel
authors.forename: Hannes
authors.initials: H
authors.lastname: Alessandrini
authors.forename: Friederike
authors.initials: F
authors.lastname: Schlingloff
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schäfer
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000628:therapy; D016896:Treatment Outcome