Transcatheter Valve-in-Valve Implantation for Failed Bioprosthetic Heart Valves

OBJECTIVES: The majority of prosthetic heart valves currently implanted are tissue valves that can be expected to degenerate with time and eventually fail. Repeat cardiac surgery to replace these valves is associated with significant morbidity and mortality. Transcatheter heart valve implantation within a failed bioprosthesis, a “valve-in-valve” procedure, may offer a less invasive alternative.

METHODS: Valve-in-valve implantations were performed in 24 high-risk patients.

RESULTS: Failed valves were aortic (n=10), mitral (n=7), pulmonary (n=6), or tricuspid (n=1) bioprostheses. Implantation was successful with immediate restoration of satisfactory valve function in all but 1 patient. No patient had more than mild regurgitation after implantation. No patients died during the procedure. Thirty-day mortality was 4.2%. Mortality was related primarily to learning-curve issues early in this high-risk experience. At baseline, 88% of patients were in New York Heart Association functional class III or IV; at the last follow-up, 88% of patients were in class I or II. At a median follow-up of 135 days (interquartile range, 46 to 254 days) and a maximum follow-up of 1045 days, 91.7% of patients remained alive with satisfactory valve function.

CONCLUSIONS: Transcatheter valve-in-valve implantation is a reproducible option for the management of bioprosthetic valve failure. Aortic, pulmonary, mitral, and tricuspid tissue valves were amenable to this approach. This finding may have important implications with regard to valve replacement in high-risk patients. Arden Key Jersey


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One Comment

  1. See post Feb 22, 2010:

    Transcatheter Aortic Valve Implantation: Role of Multi-Detector Row Computed Tomography to Evaluate Prosthesis Positioning and Deployment in Relation to Valve Function.
    Victoria Delgado, Arnold C.T. Ng, Nico R. van de Veire, Frank van der Kley, Joanne D. Schuijf, Laurens F. Tops, Arend de Weger, Giuseppe Tavilla, Albert de Roos, Lucia J. Kroft, Martin J. Schalij, Jeroen J. Bax.
    European Heart Journal. 2010; 8(2):113-123.

    See comment by Blase A. Carabello:

    Percutaneous Therapy for Valvular Heart Disease: A Huge Advance and a Huge Challenge to Do it Right.
    Blase A. Carabello.
    Circulation. April 12, 2010.

    See also:

    Evaluation of Anatomic Valve Opening and Leaflet Morphology in Aortic Valve Bioprosthesis by Using Multidetector CT: Comparison with Transthoracic Echocardiography.
    Fabien Chenot, Patrick Montant, Celine Goffinet, Agnes Pasquet, David Vancraeynest, Emmanuel Coche, Jean-Louis Vanoverschelde, and Bernhard L. Gerber.
    Radiology 2010;255 377-385.
    PMID: 20019133

    Edwards SAPIEN transcatheter heart valve in native pulmonary valve position.
    R A Bertels, N A Blom, M J Schalij.
    Heart 2010;96 661.

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