Early Degeneration of a Next-Generation Mitral Bioprosthesis in the Tricuspid Position Treated With Valve-in-Valve

Bioprosthetic tricuspid valve replacement is increasingly performed, but long-term durability data are limited. The Edwards Mitris Resilia valve, designed for the mitral position, has been used off-label in the tricuspid position, with scarce evidence of outcomes.

We report 2 patients who developed early (<2-year) structural valve degeneration of the Mitris Resilia bioprosthesis in the tricuspid position. Both presented with symptomatic severe intraprosthetic tricuspid regurgitation. Given the prohibitive surgical risk of redo sternotomy, we opted for valve-in-valve (ViV) transcatheter tricuspid valve replacement (TTVR) using the Edwards Sapien 3 Ultra Resilia transcatheter heart valve. Both procedures were successful, with no residual regurgitation or paravalvular leak.

To our knowledge, this is the first reported series of early Mitris Resilia structural valve degeneration in the tricuspid position. The cases highlight potential concerns about the durability of bioprostheses in the tricuspid position, especially in congenital heart disease or redo settings. Valve-in-valve tricuspid valve replacement with balloon-expandable transcatheter valves proved to be feasible, safe, and effective, preventing high-risk surgical reoperation. Early intervention is crucial to avoid irreversible right ventricular dysfunction.