Key result
Emergency transthoracic transapical mitral valve-in-valve implantation resulted in a well-functioning prosthesis with a mitral valve area of 3 cm2 and a mean gradient of 3 mmHg at 1 month.
Case Report (n=1)
Transapical mitral valve-in-valve implantation can serve as a safe and effective alternative to emergent surgical valve replacement in patients with failed mitral bioprostheses.
May support emergency bailout use; hypothesis-generating and requires prospective data before practice change.
OBJECTIVES: The valve-in-valve (VIV) technique is an emerging therapeutic option for patients with failure of previously implanted xenografts. We describe a balloon-expandable transthoracic transapical mitral VIV implantation in an emergency setting in a 69-year-old woman with dysfunction of the mitral bioprosthesis. METHODS: Left ventricular apical access was applied. After balloon valvuloplasty, a 26-mm Edwards-Sapien transcatheter valve (Edwards Lifesciences LLC, Irvine, CA, USA) was deployed within the mitral xenograft, using rapid ventricular pacing. RESULTS: The transcatheter valve functioned properly postoperatively and three-dimensional echocardiography carried out 1 month later showed a well-functioning VIV prosthesis and no mitral stenosis (mitral valve area 3 cm(2) , mean gradient 3 mmHg). CONCLUSIONS: In this patient, VIV implantation was found to be a safe alternative to an emergent valve replacement. It might represent a suitable option to conventional procedures even among lower risk patients.
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Garsse et al. (2011) conducted a case report in Dysfunction of mitral bioprosthesis (n=1). Transthoracic transapical mitral valve-in-valve implantation was evaluated on Valve function and mitral stenosis (mitral valve area and mean gradient). Emergency transthoracic transapical mitral valve-in-valve implantation resulted in a well-functioning prosthesis with a mitral valve area of 3 cm2 and a mean gradient of 3 mmHg at 1 month.
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