Emergency transapical mitral valve-in-valve implantation for bioprosthesis failure: transapical implantation of an Edwar
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CASE REPORT
Open Access
Emergency transapical mitral valve-in-valve implantation for bioprosthesis failure: transapical implantation of an Edwards Sapien-XT in a dysfunctional mitral bioprosthesis in a critical patient Marco Zanobini1, Sabrina Manganiello1, Giorgia Bonalumi1, Raoul Biondi1, Marco Russo2, Massimo Mapelli3, Francesco Alamanni1 and Matteo Saccocci1,2*
Abstract Background: Valve-in-Valve (VIV) Transcatheter Aortic Valve Replacement (TAVR) is now the treatment of choice in high-surgical-risk patients with failing aortic bioprosthesis. Although less performed, VIV-Transcatheter Mitral Valve Replacement (TMVR) is a valid treatment option for selected high-risk patients with degenerated mitral bioprostheses. Several cases of elective ViV- TAVR and -TMVR have been reported but only few were performed in critical hemodynamic conditions. Case presentation: We report the case of a patient underwent balloon-expandable transapical mitral valve-in-valve implantation in an emergency setting due to a severe stenosis of a bioprosthesis in mitral position. The procedure was successfully performed, with no residual mitral regurgitation or paravalvular leaks, and uneventful. Conclusion: Transcatheter transapical mitral valve-in-valve implantation could represent a feasible and effective strategy even in critical setting. Keywords: Mitral valve stenosis, Bioprosthesis, Transcatheter valve implantation, Valve-in-valve, Transapical, Mitral bioprosthesis, Emergency
Background Valve-in-Valve (VIV) Transcatheter Aortic Valve Replacement (TAVR) is now the treatment of choice in highsurgical-risk patients with failing aortic bioprosthesis [1]. Although less performed, VIV-Transcatheter Mitral Valve Replacement (TMVR) [2] represents a valid treatment option for selected high-risk patients with degenerated mitral bioprostheses. Several cases of elective ViVTAVR and -TMVR have been reported, but only a few were performed in critical hemodynamic conditions, especially for dysfunctioning mitral bioprosthesis [3–5]. * Correspondence: [email protected] 1 Department of Cardiac Surgery, IRCCS - Centro Cardiologico Monzino, Università degli Studi di Milano, Via C. Parea 4, 20138 Milano, Italy 2 Department of CardioVascular Surgery, Heart Center - University Hospital of Zurich, Zurich, Switzerland Full list of author information is available at the end of the article
Over the last decade, the use of bioprosthesis or mitral valve reconstruction, instead of mechanical valves, has shown an important worldwide increase thanks to the improved long-term results and inspired to the desire of avoiding the need of life-long systemic anticoagulation. The durability of bioprostheses, especially in mitral position, can be very variable, depending on patient’s and valve characteristics. Although surgical redo operation is often possible, when there are no specific contraindications, it’s widely known that is accompanied by an increased mortality depending on age, comorbidities and elective or urgent status of the procedure. In this scenar
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