Mitral Valve-in-Valve Implantation as an Elective or Rescue Procedure in High-Risk Patients.

BACKGROUND: Transapical transcatheter mitral valve-in-valve implantation (TA-MVIVI) for bioprosthetic valve failure is an emerging alternative to reoperation in high-risk patients. We report our outcomes in a patient population with a high proportion of cardiogenic shock.

METHODS: Retrospective review was performed of all patients undergoing TA-MVIVI with an Edwards Sapien (Edwards Life sciences, Irvine, CA) prosthesis at our center between the years 2013 and 2017.

RESULTS: Nineteen patients with bioprosthetic mitral valve failure were included (mean age 78 ± 12 years). All patients were New York Heart Association functional class III or greater; The Society of Thoracic Surgeons mean score was 22.0 ± 17.5. The TA-MVIVI was performed in the setting of cardiogenic shock in 12 of 19 patients (63%). The primary mechanism for valve failure was regurgitation in 58%, stenosis in 21%, and mixed in 21%. All patients underwent successful TA-MVIVI with no deaths, strokes, or myocardial infarctions at 30 days. Two patients had brief postprocedural cardiac arrest but had full recovery. Mean transmitral gradient decreased from 12 ± 5 mm Hg to 5 ± 3 mm Hg (p = 0.0005). There was 1 death from unknown causes within the first year (5.2%). At a mean follow-up of 339 days (range, 30 to 1291), trace transvalvular regurgitation had developed in 3 of 19 patients (15.8%). There was no paravalvular regurgitation. At last follow-up, 89.5% of patients were New York Heart Association class I or II.

CONCLUSIONS: Transapical transcatheter mitral valve-in-valve implantation can safely be performed in a patient population with a high proportion of cardiogenic shock with favorable clinical outcomes.