Expanding treatment horizons: transcatheter mitral valve-in-valve replacement in bridging to heart transplant.

Transcatheter mitral valve (MV) replacement is an option in complex MV disease with potentially more predictable treatment outcomes and less invasiveness that increases the treatment spectrum to high-risk or non-surgical patients. We present an interesting case of failed MV bioprosthesis who presented with progressively worsening heart failure for heart transplant evaluation, but was successfully managed with transcatheter mitral valve-in-valve replacement (TMViVR). This case illustrates the pivotal role of TMViVR utilization in addressing complex cardiac scenarios, particularly when re-operative surgical MV replacement poses a high risk and also bridging the gap between the present and future heart transplantation preparations by paving the way for a well-prepared patient in the subsequent phase. The lifetime disease management and patient-centric approach with meticulous risk assessment reinforces the importance of shared decision-making in complex cases.

Redo Mitral Valve Replacement After Valve-in-Valve Transcatheter Mitral Valve Replacement.

The rising preference for percutaneous mitral valve-in-valve replacement (ViV TMVR) over redo surgical mitral valve replacement (MVR) is primarily due to its reduced bleeding risk. This report details a bloodless redo MVR performed for mitral stenosis post-ViV TMVR. We present detailed intraoperative findings, including images of the extracted bioprosthetic valves and cardiac anatomy, providing valuable insights into the surgical complexities encountered. The case underscores the importance of meticulous planning and execution in redo MVR, especially in patients with a history of multiple valve interventions. Additionally, this report discusses the potential complications associated with ViV TMVR, contributing to the evolving understanding of this procedure's long-term outcomes. Our findings highlight the need for careful consideration of patient-specific factors and the inherent risks of redo valve surgeries, aiming to improve patient outcomes in complex cardiac cases.

Premature Bioprosthetic Mitral Valve Dysfunction Due to Flail Leaflet Treated With Transcatheter Mitral Valve Replacement; a Case Report.

Early bioprosthetic mitral valve failure is uncommon, but cases can present with symptomatic heart failure and require careful attention and evaluation. Transcatheter valve replacement is a minimally invasive treatment for mitral valve dysfunction that can have a considerable impact, particularly for those who are at high surgical risk or have a history of bioprosthetic valve failure. We present a rare case of significant mitral regurgitation due to the unexpected premature failure of a bioprosthetic valve that was implanted three years prior. This patient was treated with transcatheter mitral valve replacement with the implantation of an Edwards SAPIEN Ultra (Edwards Lifesciences) valve.

Same-Day Discharge After Transcatheter Native Aortic and Mitral Valve-in-Valve Replacement.

Transcatheter aortic valve replacement has become the gold standard of care in the management of patients with severe aortic stenosis and transcatheter mitral valve-in-valve replacement seems to be an attractive alternative to redo surgery. We report the first case of concomitant transcatheter aortic valve replacement/transcatheter mitral valve-in-valve replacement that was performed under conscious sedation who was subsequently discharged the same day. (Level of Difficulty: Advanced.).

Triple Valve Replacement in a Patient with Severe Combined Aortic and Mitral Stenosis.

With recent advancements and evidence in favor of transcatheter approach for valve replacements including valve-in-valve procedures, it has become a favorable choice particularly in critically ill patients. Additionally, transcatheter mitral valve-in-valve replacement (TMViVR) is emerging as a less invasive substitute for patients with early dysfunctional bioprosthetic valve. We describe the clinical course of a 52-year-old male whose initial presentation to the hospital for dyspnea on exertion secondary to combined severe aortic and mitral stenosis got complicated requiring three valvular replacement procedures with favorable outcomes.

Optimal Imaging Guidance During Transcatheter Mitral Valve-in-Valve Replacement in Bioprostheses With Radiolucent Sewing Rings.

Transcatheter mitral valve-in-valve replacement (TMVR) offers a less invasive strategy for managing bioprosthetic mitral valve dysfunction. TMVR positioning is challenging in the setting of a radiolucent bioprosthetic sewing ring. We present 2 cases demonstrating the roles of fluoroscopy and echocardiography in guiding TMVR placement within bioprostheses with radiolucent sewing rings. (Level of Difficulty: Intermediate.).

Outcomes of repeat mitral valve replacement in patients with prior mitral surgery: A benchmark for transcatheter approaches.

OBJECTIVES: With the emergence of transcatheter mitral valve-in-valve/ring replacement for deteriorated bioprostheses or failed repair, comparative clinical benchmarks for surgical repeat mitral valve replacement (re-MVR) are needed. We present in-hospital and survival outcomes of a 24-year experience with re-MVR. METHODS: From January 1992 to June 2015, 520 adult patients underwent re-MVR; 273 had undergone prior mitral valve repair (pMVP) and 247 had undergone prior MVR (pMVR). A benchmark cohort of isolated re-MVR was defined based on potential eligibility for transcatheter mitral valve-in-valve/ring replacement, resulting in 73 pMVPs with previous annuloplasty rings and 74 pMVRs with previous bioprosthetic valves for comparison. RESULTS: For the entire cohort, mean age was 64 ± 12 years for pMVP patients and 63 ± 15 years for pMVR patients (P = .281), which was similar for the benchmark cohort. Overall operative mortality was 14 out of 273 (5%) for pMVP versus 23 out of 247 (9%) for pMVR (P = .087). There were 3 operative deaths (4.1%) in both groups of the benchmark cohort (P = 1.0). For the benchmark cohort, median time to reoperation was 9.8 years for pMVP and 9.1 years for pMVR. Cox proportional hazard analysis showed that chronic kidney disease (hazard ratio [HR], 2.47; 95% CI, 1.77-3.44), endocarditis (HR, 1.49; 95% CI, 1.07-2.07), pMVR (HR, 1.45; 95% CI, 1.12-1.89), early reoperation ≤ 1 year (HR, 1.49; 95% CI, 1.02-2.17), and age (HR, 1.04/y; 95% CI, 1.03-1.05) were associated with decreased survival after re-MVR. CONCLUSIONS: A re-MVR is a high-risk operation, but in carefully selected patients such as our benchmark population, it can be performed with acceptable results. Patients undergoing pMVP also have better long-term survival compared with patients undergoing pMVR. These results will serve as a benchmark for transcatheter mitral valve-in-valve/ring replacement.