When surgery is not an option: case report of transcatheter valve-in-valve replacement for mitral valve dysfunction

Heart valve diseases affect over 100 million people globally, with mitral regurgitation being the most common in developed countries. Bioprosthetic heart valves, frequently used for replacement, typically last 10-15 years before degeneration. Repeat open-heart surgery for valve replacement poses high risks, especially in older or high-risk patients. Following the success of transcatheter aortic valve replacement, transcatheter mitral valve-in-valve replacement has emerged as a less invasive alternative for patients deemed inoperable due to high surgical risks.

We report the case of a 69-year-old male with a history of mitral bioprosthetic valve replacement and thoracic radiotherapy who presented with shortness of breath and NYHA class 3 functional capacity. Echocardiography revealed bioprosthetic valve dysfunction with a mean gradient of 13 mmHg and pulmonary artery pressure of 70 mmHg. Given his high surgical risk (The Society of Thoracic Surgeons score 10.9%, EuroScore2 9.8%) and prior thoracic radiotherapy, a transcatheter valve-in-valve procedure was planned. A 29 mm MyVal valve was successfully implanted via a transseptal approach, resulting in complete resolution of mitral regurgitation and a mean gradient of 3 mmHg post-procedure. The patient was discharged without complications and reported improved functional capacity (NYHA class 1) at follow-up.

This case highlights the successful application of transcatheter valve-in-valve replacement for a patient with bioprosthetic mitral valve dysfunction who was at high surgical risk. The procedure, performed using a transseptal approach with a 29 mm MyVal valve, resulted in significant symptomatic and hemodynamic improvement with no complications. The patient's functional capacity improved dramatically, and follow-up imaging confirmed the effective functioning of the new valve. This case supports the viability of transcatheter techniques as a preferred alternative for inoperable patients with mitral valve dysfunction, contributing valuable insights to the growing field of minimally invasive cardiac interventions. As technology advances, transcatheter solutions are expected to offer safer and more effective treatments for bioprosthetic valve failures.