Re-do mitral valve replacement using the valve-on-valve technique: a case report.

Area of Science:

• Cardiovascular Surgery
• Biomedical Engineering
• Prosthetic Heart Valves

Background:

• Degeneration of bioprosthetic heart valves necessitates reoperation, posing surgical challenges.
• Previous mitral valve replacement (MVR) with a bioprosthesis can lead to complications upon re-do surgery.
• Embedded struts of degenerated bioprostheses can complicate complete removal during re-do MVR.

Observation:

• A 49-year-old female patient presented with severe mitral bioprosthetic valve regurgitation 20 years post-initial MVR.
• The degenerated bioprosthesis had struts embedded in the left ventricular myocardium.
• Pulmonary edema was secondary to the severe mitral regurgitation.

Findings:

• A successful re-do mitral valve replacement (re-do MVR) was performed using the valve-on-valve technique.
• A 25 mm mechanical prosthesis was implanted within the degenerated 29 mm bioprosthesis.
• The valve-on-valve technique simplified the procedure and avoided risks of complete explantation.

Implications:

• The valve-on-valve technique offers a simplified and safer alternative for re-do MVR in cases of degenerated bioprostheses.
• This technique can mitigate risks of cardiac rupture and reduce operative time.
• It represents a potentially valuable strategy for managing patients with degenerated mitral bioprosthetic valves.