A novel case of transcatheter mitral valve-in-valve replacement using Mi-thos^TM system

Transcatheter mitral valve replacement(TMVR)has become an alternative to surgical mitral valve replacement for the treatment of patients with severe mitral insufficiency(MI)who are at very high or prohibitive surgical risk.[1]Because of impaired left ventricular dysfunction and previous cardiac surgery,some aged patients with degenerated bioprosthetic mitral valve and mitral regurgitation were refused to redo surgery.[2]Increasing demand are required for minimally invasive treatment of these patients.Hundreds of patients worldwide have been treated with a transcatheter mitral valve-in-ring or valve-in-valve procedure using transcatheter aortic valve.[3]However,rare case of transcatheter mitral valve-in-valve/ring replacement using transcatheter mitral valve system was reported.Here,we reported a successfully case of transcatheter mitral“valve-in-valve”replacement for the treatment of bioprosthetic mitral valve degeneration and severe regurgitation with domestic Mithos^TM valve.

Feasibility and short-term outcomes of transcatheter valve-in-valve implantation for failed aortic and mitral bioprosthesis-a single-center experience

Objectives Transcatheter valve-in-valve （VIV） implantation for failed bioprostheses has become an alternative to open surgery in those deemed high risk. The purpose of this study was to evaluate the effectiveness and outcomes of this emerging procedure. Methods Fourty VIV procedures were performed in 38 consecutive patients （mean age 70 ± 14 years and mean Logistic EuroScore 23.6 ± 15.5%） with severe aortic （n = 19） or mitral （n = 21） bioprosthetic valve dysfunction between 2014 and 2017. Bioprosthetic failure was secondary to stenosis in 11 （27.5%）, regurgitation in 19 （47.5%）, and combined in 10 （25.0%） bioprostheses. Clinical, echocardiographic, and procedural profiles were characterized, and the short-term results of the study patients were reported. Results Successful transfemoral （n = 15）, trans-subclavian （n = 1）, or transapical （n = 3） aortic VIV using either balloon-expandable valves （Edwards Sapien XT, n = 7） or self-expandable valves （Medtronic CoreValve, n = 12）; and transapical （n = 21） mitral VIV using either Edwards Sapien XT （n = 15） or me-chanically expandable valves （Boston Scientific Lotus, n = 6） were accomplished in all 40 VIV procedures. Implantation was successful with immediate restoration of satisfactory valve function in all patients. Five patients （13.2%） died at a median follow up of 9.3 months. Most of the 33 patients alive were in good functional status with good prosthetic valve performance. Conclusions Transcatheter VIV implantation is a feasible and safe option for the management of bioprosthetic valve failure. It may offer a less invasive alternative for those high-risk patients needing repeat valve replacement.

Will Transcatheter Aortic Valve Replacement(TAVR)be the Primary Therapy for Aortic Stenosis?

Transcatheter aortic valve replacement(TAVR)is increasingly used for the treatment of high or very high surgical risk patients with severe aortic stenosis(AS)or failing surgical bioprosthesis(valve-in-valve,VIV-TAVR).In TAVR,the collapsed transcatheter heart valve(THV)is introduced using the delivery system inserted from the femoral artery(preferred)or other alternative accesses(transapical,transaortic,transcarotid,subclavian/transinnominate or transcaval).The delivery system is then advanced until coaxially aligned with the aortic annulus,where the THV is deployed.This procedure can be associated with complications such as access site injury(vascular complication),paravalvar leak,cerebrovascular events and conduction disturbances.However,the rapid acceptance and successes observed with TAVR have been made possible through careful patient selection,preprocedural planning(i.e.MDCT annular sizing),THV technology(i.e.new generation valves),and procedural techniques(i.e.minimalist TF-TAVR and alternative percutaneous access options),as well as a decrease in complications as TAVR experience grows.Though the results or ongoing clinical trials evaluating TAVR in intermediate surgical risk patients are pending,it is likely that TAVR will soon be approved for lower risk patients as well.