Transapical transcatheter valve-in-valve implantation for failed mitral valve bioprosthesis

Eyal R. Nachum, Ehud Raanani, Amit Segev, Victor Guetta, Ilan Hai, Amihai Shinfeld, Paul Fefer, Hamdan Ashraf, Israel Barabash, Amjad Shalabi, Dan Spiegelstein

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: The rate of mitral bioprosthesis implantation in clinical practice is increasing. Transcatheter valve-invalve implantation has been described for high risk patients requiring redo valve surgery. Objectives: To report our experience with transapical valve-invalve implantation for failed mitral bioprosthesis. Methods: Since 2010, 10 patients have undergone transapical valve-in-valve implantation for failed bioprosthesis in our center. Aortic valve-in-valve implantation was performed in one of them and mitral valve-in-valve implantation in nine. Mean age was 82 ± 4 years and 6 were female (67%). Mean time from original mitral valve (MV) replacement to valve-in-valve procedure was 10.5 ± 3.7 years. Follow-up was completed by all patients with a mean duration of 13 ± 12 months. Results: Preoperatively, all patients presented with significant mitral regurgitation, two with mitral stenosis due to structural valve failure. All nine patients underwent successful transapical valve-in-valve implantation with an Edwards Sapien™ balloon expandable valve. There was no in-hospital mortality. Mean and median hospital duration was 15 ± 18 and 7 days respectively. Valve implantation was successful in all patients and there were no major complications, except for major femoral access bleeding in one patient. At last follow-up, all patients were alive and in NYHA functional class I or II. Echocardiography follow-up demonstrated that mitral regurgitation was absent or trivial in seven patients and mild in two. At follow-up, peak and mean gradients changed from 26 ± 4 and 8 ± 2 at baseline to 16.7 ± 3 and 7.3 ± 1.5, respectively. Conclusions: Transcatheter transapical mitral valve-in-valve implantation for failed bioprosthesis is feasible in selected high risk patients. Our early experience with this strategy is encouraging. Larger randomized trials with long-term clinical and echocardiographic follow-up are recommended.

Original languageEnglish
Pages (from-to)13-17
Number of pages5
JournalIsrael Medical Association Journal
Issue number1
StatePublished - Jan 2016
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2016 Israel Medical Association.


  • Minimally invasive surgery
  • Mitral bioprosthesis
  • Transapical valve implantation
  • Transcatheter aortic valve implantation (TAVI)
  • Valve in valve


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