Transcatheter aortic and mitral valve implantations for failed bioprosthetic heart valves

Restoring degenerated bioprosthetic valves by transcatheter valve implantation may obviate the need for redo surgery in carefully selected patients. We present our initial experience with valve-in-valve (VIV) procedures for failed aortic and mitral bioprosthetic valves.

Data were collected for all patients who underwent VIV procedures at a tertiary medical center (n = 6). Findings were analyzed and compared with those for transcatheter valve implantation in native valves at the same center during the last 3 years (n = 84).

Six patients of mean age 78.3 ± 13.8 years (range, 51-87) underwent VIV procedures with the CoreValve (n = 4) or Edwards-SAPIEN device (n = 2). Four (66%) had a failed prosthetic aortic valve, and 2 (33%) had a failed prosthetic mitral valve. Regurgitation accounted for valve failure in 83.3% of the VIV group versus 1.2% of the comparison group (p < 0.001). Procedural success and 30-day survival rates were 100%. Patient functional class improved significantly from 0% class I/II, 50% class III, and 50% class IV before the procedure to 66% class I, 33% class II, and 0% class III/IV after (p < 0.001).

This preliminary experience demonstrates that in carefully selected cases, transcathether valve implants can be safely and effectively deployed in stenotic and/or regurgitant degenerated bioprosthetic valves. Further evaluations in larger series are needed.