The transcatheter valve-in-valve (VIV) procedure for failed aortic bioprostheses is recognized as an alternative treatment to conventional surgery in high-risk patients. This less invasive option has now been applied to failed mitral bioprostheses (VIV) or failed repairs i.e. valve-in-ring (VIR). In this emerging field, to get an optimal result, a good understanding of the design features of the failed surgical heart valve/ring, the transcatheter heart valve being used and their compatibility, is of paramount importance. Although similar in many ways to the aortic counterpart, a mitral VIV/VIR procedure can pose certain different challenges such as delayed migration and left ventricular outflow tract obstruction. This review describes the features of bioprostheses, rings and THVs relevant to a VIV/VIR procedure, and also provides guidance regarding sizing, positioning and how to avoid some of the major complications therefore improving the chances of a successful outcome.
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Clinical Outcomes of Transcatheter Mitral Valve-In-Valve and Valve-In-Ring Implantation: A Systematic Review and Meta-Analysis.
Catheter Cardiovasc Interv
January 2025
Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore.
Article Synopsis
- Transcatheter valve-in-valve (VIV) and valve-in-ring (VIR) therapies for failing mitral bioprosthetic valves are being researched to understand their effectiveness and safety over time.
- A meta-analysis reviewed 34 studies involving 7,047 patients to assess short and long-term outcomes, focusing on complications like mortality, stroke, and procedural success rates.
- Findings indicated high success rates of 94.8% for VIV and 80.5% for VIR, with varying short-term mortality and stroke risks across VIV, VIR, and traditional redo surgical mitral valve replacements (SMVR).
Valve-in-valve/valve-in-ring transcatheter mitral valve implantation vs. redo surgical mitral valve replacement for patients with failed bioprosthetic valves or annuloplasty rings: A systematic review and meta-analysis.
Heliyon
May 2023
Department of Cardiovascular Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Background: Valve-in-valve (ViV)/valve-in-ring (ViR) transcatheter mitral valve implantation (TMVI) is a less invasive alternative to redo surgical mitral valve replacement (SMVR). To further verify its feasibility, we aimed to appraise early clinical outcomes after either ViV/ViR TMVI or redo SMVR for failed bioprosthetic valves or annuloplasty rings, as a comparison of long-term follow-up results are not available for these procedures.
Methods: We systematically searched PubMed, Cochrane Controlled Trials Register, EMBASE, and Web of Science to identify studies that compared ViV/ViR TMVI and redo SMVR.
Transcatheter valve-in-valve or valve-in-ring implantation with a novel balloon-expandable device in patients with bioprosthetic left side heart valves failure: 1-year follow-up from a multicenter experience.
Int J Cardiol
April 2023
Cardiology Division, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy.
Background: Transcatheter aortic and mitral valve-in-valve (ViV) or valve-in-ring (ViR) implantation into failed bioprosthetic heart valves (BHVs) or rings represents an appealing, less invasive, treatment option for patients at high surgical risk. Nowadays, few data have been reported on the use of balloon-expandable Myval (Meril Life Science, Vapi, India) transcatheter heart valve (THV) for the treatment of degenerated BHVs or rings. We aimed at evaluating the early and mid-term clinical outcomes of patients with left side heart bioprosthesis deterioration treated with transcatheter ViV/ViR implantation using Myval THV.
View Article and Find Full Text PDFTranscatheter mitral valve replacement for degenerated mitral valve bioprostheses, failure of mitral valvuloplasty and native valve with severe mitral annulus calcification: a systematic review and meta-analysis.
J Cardiothorac Surg
October 2021
Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China.
Background: Although transcatheter technology has achieved some success in the field of mitral valves, the feasibility of applying it to patients with degenerated mitral valve bioprostheses (valve-in-valve, ViV), failure of mitral valvuloplasty (valve-in-ring, ViR) and serious mitral annulus calcification (vale-in-MAC, ViMAC) has not been effectively evaluated.
Methods: By searching published literature before December 5, 2020 in four databases, we found all the literature related to the evaluation of feasibility assessment of TMViV, TMViR and TMViMAC. Outcomes focused on all-cause mortality within 30 days, bleeding and LVOT obstruction.
Iatrogenic atrial septal defect closure after transseptal mitral valve interventions: Indications and outcomes.
Catheter Cardiovasc Interv
November 2019
Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California.
Objectives: Review indications and outcomes for transcatheter iatrogenic atrial septal defect (iASD) closure in patients undergoing MitraClip or transseptal (TS) mitral valve-in-valve/ring (ViV/ViR) procedures.
Background: Mitral valve transcatheter interventions require large-diameter TS sheaths that can result in iASDs that necessitate post-procedure transcatheter closure. Although the presence of iASD has been well-described, indications for closure and outcomes after TS mitral valve interventions have not been reported.
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