Transcather Mitral Valve-in-Valve Replacement: The New Frontier in Heart Valve Therapy

Schilling J and Islam AM

Department of Medicine, Baystate Medical Center, USA

^*Correspondance to: Ashequl M. Islam 

 PDF  Full Text DOI: 10.25107/2474-1647.1051

Abstract

Introduction: Surgical valve replacement is not always feasible in patients with severe mitral regurgitation from a failing bioprosthetic valve or severe mitral annular calcification. Off-label use of transcatheter aortic valves has been described in the literature as a possible method of valve replacement for this patient population. We review the literature on this practice as well as present two cases of successful implantation of the Sapien XT valve in the mitral position.Case Series: Two patients were selected for implantation of a transcatheter valve in the mitral position due to their prohibitively high surgical risk. A transapical approach was used. One of the patients utilized venous-arterio extracorporeal mechanical oxygenation. The procedure was performed in a hybrid OR under general anesthesia. Successful implantation of both valves was achieved with survival beyond 30 days in each patient.Discussion: There have been 113 cases of valve-in-valve and valve-in-ring procedures described in the literature. There have also been 11 cases of implantation into a native valve with severe mitral annular calcification. Both of these methods are feasible, however the architecture of the native mitral valve annulus is best suited for a dedicated mitral prosthesis. These dedicated transcatheter mitral valves are undergoing early safety and feasibility trials.
Conclusion: There has been early success with utilizing transcatheter aortic valves in the mitral position; however this practice will likely be temporary as dedicated transcatheter mitral valves progress through their development.

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Cite the article

Schilling J, Islam AM. Transcather Mitral Valve-in-Valve Replacement: The New Frontier in Heart Valve Therapy. Clin Surg. 2016; 1: 1051.