Single and multicentre TAVI registries
Transcatheter mitral valve-in-valve/valve-in-ring implantations for degenerative post-surgical valves: results from the global valve-in-valve registry
Aims: Transcatheter mitral valve-in-valve / valve-in-ring implantation is an emerging therapeutic alternative for patients with failed mitral valves after surgical intervention and may obviate the need for a redo operation. We aimed to evaluate the clinical results of this technique using a large worldwide registry.
Methods and results: The registry included 70 patients with degenerated mitral valves after surgical intervention (11.4% ring only, median of nine years post procedure) from 17 centres. Mean age 74.0±11.3 years; 70% female (STS score 16.2±10.4%). The mode of failure was regurgitation (n=36, 51.4%), stenosis (n=13, 18.6%), and combined stenosis and regurgitation (n=21, 30%). Transcatheter Edwards SAPIEN (Edwards Lifesciences, Irvine, CA, USA) implantation was performed in all cases (23 mm in 22.9%, 26 mm in 58.6%, and 29 mm in 18.6%). Procedural access was transapical in 60 cases (85.7%); transseptal in seven (10%), and through the left atrium via right mini-thoracotomy in three (4.3%). Combined procedures included three aortic valve-in-valves, transapical aortic valve replacement, tricuspid valve-in-ring implantation, and transapical paravalvular leak closure. Device malposition appeared in 4.3% of cases and post-implantation valvuloplasty was utilised in 12.1%. Post procedure, mitral valve area was 2.1±0.6 cm2, valve maximum / mean gradients were 13.6±6.4 mmHg / 6.4±2.7, respectively, and significant mitral regurgitation (≥+2) was observed in 5.7% of patients. Median length of hospital stay was seven days. At 30-day follow-up, all-cause mortality was 10.3% and 82.3% were at New York Heart Association functional Class I/II.
Conclusions: Mitral valve-in-valve/ valve-in-ring implantations, performed in very high-risk patients, were clinically effective in most patients with degenerative mitral valves after surgery. The safety and efficacy of this approach should be further examined.
