Prosthetic Valve-on-Valve Mitral Valve Re-Replacement: A Novel Approach.

Repeat mitral valve replacement in patients who underwent mechanical replacement during infancy may be technically very difficult due to the small-sized annulus accommodating the prosthesis. That can lead to dense fibrosis of the small annulus onto the sewing cuff. An attempt at explanting the prosthesis carries high risk of circumflex coronary artery injury or atrioventricular junction disruption. We present a novel approach to prevent a disaster in such a difficult scenario-implanting the new prosthesis above the previous prosthetic housing after removing the prosthetic leaflets.