Reoperation due to degenerated bioprostheses is an important factor of high-risk thoracic surgeries. In 2020 ACC/AHA guideline, Valve in Valve (ViV) was recommended for high-risk patient instead of surgical mitral valve replacement. This report described a 77-year-old male patient with a failed mitral bioprosthetic valve, evaluated at high risk of surgery, received a transvenous, transseptal transcatheter mitral valve replacement (TMVR). Tracheal intubation was removed at CCU 3 h after surgery without discomfort such as polypnea. The patient was transferred out of the CCU and discharged on the 3rd day. Compared with transapical access, transvenous transseptal access was less invasive, with shorter duration in CCU and hospitalization.
Objective To summarize the short-term results of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) in the treatment of bioprosthetic valve failure after aortic valve replacement. Methods We reviewed the clinical data of patients who underwent ViV-TAVI from 2021 to 2022 in the First Affiliated Hospital of Zhengzhou University. The valve function was evaluated by echocardiography before operation, immediately after operation and 3 months after operation. The all-cause death and main complications during hospitalization were analyzed. Results A total of 13 patients were enrolled, including 8 males and 5 females with a mean age of (65.9±8.5) years, and the interval time between aortic valve replacement and ViV-TAVI was (8.5±3.4) years. The Society of Thoracic Surgeons mortality risk score was 10.3%±3.2%. None of the 13 patients had abnormal valve function after operation. The mean transvalvular pressure gradient of aortic valve was decreased (P<0.001), the peak flow velocity of aortic valve was decreased (P<0.001), and the left ventricular ejection fraction was not changed significantly (P=0.480). There were slight perivalvular leakage in 2 patients and slight valve regurgitation in 3 patients. Three months after operation, the mean transvalvular pressure difference and peak flow velocity of aortic valve in 12 patients were significantly decreased compared with those before operation (P≤0.001). Conclusion This study demonstrates that ViV-TAVI for the treatment of bioprosthetic valve failure after aortic valve replacement is associated with favorable clinical and functional cardiovascular benefits, the short-term results are satisfactory.
Biological valves can lead to structural valve degeneration (SVD) over time and due to various factors, reducing their durability. SVD patients need to undergo valve replacement surgery again, while traditional open chest surgery can cause significant trauma and patients often give up treatment due to intolerance. Research has shown that as an alternative treatment option for reoperation of thoracic valve replacement surgery, redo-transcatheter aortic valve replacement for SVD is safe and effective, but still faces many challenges, including prosthesis-patient mismatch, high cross valve pressure difference, and coronary obstruction. This article aims to review the strategies, clinical research status and progress of redo-transcatheter aortic valve replacement in SVD patients.
“Valve-in-valve” technique is an effective method to treat the bioprosthesis structural valve degeneration. In this paper, an 82-year-old male patient with severe aortic valve regurgitation had underwent surgical aortic valve replacement. He had a bioprosthesis structural valve degeneration which caused severe aortic stenosis more than 3 years after surgery. His symptoms of chest distress and short breath were aggravated progressively, and not relieved by conventional treatment. As the deterioration in his unstabled circulation system, an emergency transcatheter aortic valve replacement was conducted for him. The operation was finally successful, the symptoms were relived significantly after operation, and then the follow-up indicated that he had a good recovery.
Abstract： Objective To investigate the early and mid-term outcomes of morphologic tricuspid valve replacement by means of intravalvular implantation in corrected transposition of great arteries（cTGA）. Methods From January 2009 to January 2012，11 patients with cTGA were surgically treated in Fu Wai Hospital. There were 9 male patients and 2 female patients with their mean of age of（37.8±11.7）years and mean body weight of（73.0±11.3）kg. All the patients underwent morphologic tricuspid valve replacement with preservation of the entire valvular and subvalvular apparatus. Simultaneous surgical procedures included repair of ventricular septal defect in 2 patients，repair of atrial septal defect in 4 patients，pulmonary valvuloplasty in 1 patient，reconstruction of functional right ventricular outflow tract in 4 patients and repair of coronary-pulmonary artery fistula in 1 patient. Postoperative New York Heart Association （NYHA） classification, cardiothoracic ratio, morphological right ventricle ejection fraction, end-diastolic dimension of morphological right ventricle and left atrium were evaluated during follow-up. Results All the 11 patients were successfully surgically treated and followed up for an average duration of（13.0±10.6）months. There was no statistical difference between postoperative and preoperative average cardiothoracic ratio （0.54±0.06 vs. 0.57±0.09，t=1.581，P＞0.05），morphologic right ventricle ejection fraction （52.8%±9.0% vs. 54.9%±9.5%, t =0.712，P＞0.05），and end-diastolic dimension of . morphological right ventricle （54.3±7.5 mm vs. 56.9±9.2 mm，t =0.988，P＞0.05）. There was statistical difference between postoperative and preoperative average end-diastolic dimension of left atrium（42.1±8.9 mm vs. 53.4±11.1 mm，t =3.286，P＜0.05）and NYHA classification（Z = -2.640，P＜0.05）. Conclusion Intravalvular implantation of morphologic tricuspid prosthesis can protect the physiological structure of morphologic right ventricular and prevent furtherdamage to its function caused by morphologic tricuspid valve insufficiency. Postoperative dimension of morphologic left atrium and cardiac function are significantly improved. The early and mid-term outcomes are satisfactory．
Along with the coming of aged society, the prevalence of heart valvular disease is significantly increasing, and the use of bioprosthetic valves for treating patients with severe valve disease has increased over the last two decades. As a consequence, a growing number of patients with surgical bioprosthesis degeneration is predicted in the near future. In this setting, valve-in-valve (ViV) transcatheter aortic/mitral valve replacement (TAVR/TMVR) has emerged as an alternative to redo surgery. A deep knowledge of the mechanism and features of the failed bioprosthetic heart valve is pivotal to plan an adequate procedure. Multimodal imaging is fundamental in the diagnostic and pre-procedural phases. The immediate and mid-term clinical and hemodynamic results have demonstrated the safety and feasibility of ViV techniques, but the development of these techniques faces several specific challenges, such as coronary obstruction, potential post-procedural mismatch and leaflet thrombosis. This article reviews the current status and prospects of ViV-TAVR technology in the treatment for biological valve degeneration, and suggests that ViV-TAVR should be promoted and implemented in existing medical centers with good surgical aortic valve replacement experience, so as to provide better treatment for patients.
ObjectiveTo explore the short-term follow-up clinical effect of transcatheter valve-in-valve implantation treatment for mitral bioprosthesis deterioration.MethodsThe single center data of elderly patients with mitral valve bioprosthetic dysfunction who received transapical J-Valve intervention between January 2019 and May 2020 were reviewed and summarized. After the informed consent was signed, single lumen endotracheal intubation was performed under general anesthesia in hybrid operating room. The left intercostal small incision was used to explore the apical area. Fluoroscopy and three-dimensional esophageal ultrasound were used to guide the puncture needle. Then the guide wire entered the left atrium through the mitral valve biological valve. The catheter was exchanged, and the rigid support wire was exchanged. The reverse loaded J-Valve system was guided and implanted into the biological mitral valve with beating heart. The appropriate implantation depth was adjusted, and stent valve was released under rapid pacing. Post balloon dilation of the valve was performed if necessary.ResultsFrom January 2019 to May 2020, transcatheter J-Valve implantation was completed in 20 patients with mitral valve dysfunction and high-risk evaluation of routine thoracotomy and cardiopulmonary bypass (the Society of Thoracic Surgeon score above 6). In terms of the type of the the mitral bioprosthesis, there were 6 cases of Hancock valves, 7 cases of Perimount valves, 6 cases of Epic valves, and 1 case of Baxiter valve. In terms of the size of the the mitral bioprosthesis, there were 2 cases of size 29 valves, 11 cases of size 27 valves, and 7 cases of size 25 valves. One valve fell into the left ventricle at early stage. One patient had mild valve displacement during operation, and a second valve was implanted at the same time. The success rate of valve-in-valve implantation was 95%. The length of stay in intensive care unit was less than 6 h in 5 cases, 6-24 h in 13 cases, 24-48 h in 1 case, and more than 48 h in 1 case. No patient’s postoperative mitral regurgitation was moderate or above. The mean mitral valve pressure gradient was (5.2±2.3) mm Hg (1 mm Hg=0.133 kPa). Patients recovered well after the valve-in-valve implantation treatment, with no death within postoperative one month. One patient died of infection and multiple organ failure during follow-up after one month. Other patients recovered smoothly without serious complications.ConclusionsThe clinical effect of J-Valve intervention in the treatment of mitral valve bioprosthetic dysfunction through apical approach is good. The implantation can be completed under beating heart, avoiding cardiopulmonary bypass and routine thoracotomy cardiac arrest, which is worthy of further observation and follow-up.
We reported a case of a 61-year-old female patient, six years status post her last cardiac surgery, who was admitted with a chief complaint of bilateral lower extremity edema for over a year, which had acutely worsened with associated chest pain for two days. The patient had a complex cardiac surgical history: 12 years prior, she underwent double valve replacement (aortic and mitral) plus tricuspid valvuloplasty for mitral valve prolapse with severe regurgitation and moderate-to-severe aortic regurgitation. Nine years ago, she underwent bioprosthetic mitral valve replacement and vegetation removal for prosthetic valve vegetation with severe regurgitation. Six years ago, she underwent a transapical transcatheter mitral valve replacement and mitral balloon valvuloplasty due to prosthetic mitral valve prolapse with severe regurgitation. Following evaluation during this admission, she successfully underwent a valve-in-valve transcatheter aortic valve replacement (ViV-TAVR). The patient had an uneventful postoperative recovery. This case report aims to explore the clinical strategy and application of the ViV-TAVR technique for managing bioprosthetic valve failure in patients with a history of complex valvular surgeries.
Mitral valve replacement is one of the most common heart valve surgeries in China. In recent years, with the increase in degenerative valve diseases, older patients, and the progress of anti-calcification technology of biological valves, the proportion of mitral valve biological valve replacement has been increasing year by year. After the damage of traditional mitral valve biological valves, re-operation of valve replacement with thoracotomy is required. However, the adhesion between the heart and sternum, as well as the damage caused by cardiopulmonary bypass and cardiac arrest, can cause significant trauma to elderly patients and those with multiple organ dysfunction, leading to increased mortality and complication rates. In recent years, interventional valve surgery, especially transcatheter valve-in-valve surgery, has developed rapidly. This procedure can correct the damaged mitral valve function without stopping the heart, but there are still many differences between its technical process and conventional aortic valve replacement surgery. Therefore, organizing and writing multicenter expert recommendations on the technical process of transcatheter valve-in-valve surgery for damaged mitral valve biological valves is of great significance for the training and promotion of this technology.