Reoperation due to degenerated bioprostheses is an important factor of high-risk thoracic surgeries. In 2020 ACC/AHA guideline, Valve in Valve (ViV) was recommended for high-risk patient instead of surgical mitral valve replacement. This report described a 77-year-old male patient with a failed mitral bioprosthetic valve, evaluated at high risk of surgery, received a transvenous, transseptal transcatheter mitral valve replacement (TMVR). Tracheal intubation was removed at CCU 3 h after surgery without discomfort such as polypnea. The patient was transferred out of the CCU and discharged on the 3rd day. Compared with transapical access, transvenous transseptal access was less invasive, with shorter duration in CCU and hospitalization.
Surgical bioprosthetic valve in the mitral position typically degenerates in 10-15 years, when intervention is required again. In the past, redo surgical mitral valve replacement has been the only treatment choice for such patients suffering from bioprosthetic valve failure, despite the even higher risk associated with redo open-heart surgery. In recent years, transcatheter valve-in-valve implantation in the mitral position has evolved as an reasonable alternative to redo surgery for the treatment of surgical mitral bioprosthetic valve failure. Here we report an 81-year-old female patient with surgical mitral bioprosthetic valve failure, who successfully underwent valve-in-valve transcatheter mitral valve replacement via the transfemoral-transseptal approach. The procedure was successful owing to comprehensive CT imaging work-up, despite the technical challenges associated with bilateral giant atria and small left ventricle.
ObjectiveTo explore the short-term follow-up clinical effect of transcatheter valve-in-valve implantation treatment for mitral bioprosthesis deterioration.MethodsThe single center data of elderly patients with mitral valve bioprosthetic dysfunction who received transapical J-Valve intervention between January 2019 and May 2020 were reviewed and summarized. After the informed consent was signed, single lumen endotracheal intubation was performed under general anesthesia in hybrid operating room. The left intercostal small incision was used to explore the apical area. Fluoroscopy and three-dimensional esophageal ultrasound were used to guide the puncture needle. Then the guide wire entered the left atrium through the mitral valve biological valve. The catheter was exchanged, and the rigid support wire was exchanged. The reverse loaded J-Valve system was guided and implanted into the biological mitral valve with beating heart. The appropriate implantation depth was adjusted, and stent valve was released under rapid pacing. Post balloon dilation of the valve was performed if necessary.ResultsFrom January 2019 to May 2020, transcatheter J-Valve implantation was completed in 20 patients with mitral valve dysfunction and high-risk evaluation of routine thoracotomy and cardiopulmonary bypass (the Society of Thoracic Surgeon score above 6). In terms of the type of the the mitral bioprosthesis, there were 6 cases of Hancock valves, 7 cases of Perimount valves, 6 cases of Epic valves, and 1 case of Baxiter valve. In terms of the size of the the mitral bioprosthesis, there were 2 cases of size 29 valves, 11 cases of size 27 valves, and 7 cases of size 25 valves. One valve fell into the left ventricle at early stage. One patient had mild valve displacement during operation, and a second valve was implanted at the same time. The success rate of valve-in-valve implantation was 95%. The length of stay in intensive care unit was less than 6 h in 5 cases, 6-24 h in 13 cases, 24-48 h in 1 case, and more than 48 h in 1 case. No patient’s postoperative mitral regurgitation was moderate or above. The mean mitral valve pressure gradient was (5.2±2.3) mm Hg (1 mm Hg=0.133 kPa). Patients recovered well after the valve-in-valve implantation treatment, with no death within postoperative one month. One patient died of infection and multiple organ failure during follow-up after one month. Other patients recovered smoothly without serious complications.ConclusionsThe clinical effect of J-Valve intervention in the treatment of mitral valve bioprosthetic dysfunction through apical approach is good. The implantation can be completed under beating heart, avoiding cardiopulmonary bypass and routine thoracotomy cardiac arrest, which is worthy of further observation and follow-up.
One of its primary surgical treatments of tricuspid regurgitation is tricuspid valve biological valve replacement. Catheter tricuspid valve-in-valve implantation is a novel interventional alternative for biological valve failure. The non-invasive lung fluid measuring device remote dielectric sensing (ReDSTM) has been increasingly incorporated into clinical practice as a means of monitoring chronic heart failure in recent years. This report describes the process and outcomes of the first instance of perioperative lung fluid volume evaluation following transcatheter tricuspid valve implantation utilizing ReDSTM technology. The patient has a short-term, substantial increase in postoperative lung fluid volume as compared to baseline.
Objective To summarize the early results and clinical experience of using the J-Valve for transcatheter valve-in-valve implantation in patients with degenerated bioprosthesis at different anatomic positions. Methods A retrospective analysis was conducted to evaluate the short-term outcomes of 39 consecutive patients who underwent transcatheter valve-in-valve implantation using the J-Valve System in the Department of Cardiac Surgery of Guangdong Provincial People’s Hospital from April 2020 to August 2021 due to bioprosthetic degeneration at different anatomic positions. Among them, 35 patients underwent transcatheter mitral valve-in-valve (TMViV) implantation, 1 transcatheter aortic valve-in-valve (TAViV) implantation, 1 transcatheter tricuspid valve-in-valve (TTViV) implantation, 1 TMViV implantation with simultaneous TAViV implantation, and another one TMViV implantation with simultaneous transcatheter aortic valve replacement (TAVR) and perivalvular leakage (PVL) closure. Results Among the 35 patients who underwent isolated TMViV implantation, 17 were male and 18 were female with a mean age of 72.6±10.8 years. Mean duration between two operations was 10.5±2.7 years. The mean Society of Thoracic Surgeons and EuroSCORE Ⅱ scores were 12.95%±9.61% and 13.91%±8.94%, respectively. The device success rate was 97.1% and no death occured during the operation. One patient was transferred to thoracotomy due to device displacement, 1 was re-opened for uncontrolled bleeding, and 1 presented left ventricular outflow tract obstruction. One patient underwent craniotomy due to intracranial hemorrhage within 30 days after surgery, and no other complications occurred including death, stroke, permanent pacemaker implantation, cardiac tamponade, or re-hospitalization. The mean follow-up time was 6.0±4.4 months, the mean mitral valve gradient was significantly improved (10.4±2.0 mm Hg vs. 5.5±1.2 mm Hg, P<0.05), and the New York Heart Association class≤Ⅱ in all the patients at the last follow-up. Among the other 4 patients who did not undergo isolated TMViV implantation, the transapical TAViV implantation and the trans-right atrium TTViV implantation were successful without intra- or post-operative complications. The patient who underwent TMViV and TAViV implantation simultaneously via transapical approach died of severe pulmonary hemorrhage and multiple organ failure 16 days after surgery. The other patient who underwent transapical TMViV combined with TAVR and PVL closure died of septic shock 10 days after the surgery. Conclusion Transcatheter valve-in-valve implantation using the J-Valve system is shown to be a safe and effective procedure to treat mitral, aortic and tricuspid bioprosthetic valve dysfunction in high-risk patients, providing a new alternative to surgical surgery for degenerated bioprosthesis at different anatomic positions. However, simultaneous different valves intervention should be very cautious.
ObjectiveTo summarize the results and clinical experience of transcatheter valve-in-valve implantation using domestic self-expanding valve in patients with aortic degenerated bio-prosthesis. MethodsFrom January 2019 to April 2023, the patients who underwent transcatheter valve-in-valve surgery in the Department of Cardiac Surgery of Tianjin Chest Hospital due to surgical bio-prosthesis failure were included. Characteristics of valves, perioperative complications, and hemodynamic manifestations during the early postoperative and follow-up period were analyzed. ResultsA total of 24 patients were enrolled, including 14 males and 10 females with an average age of 68.17±7.72 years, and the average interval between the two operations was 10.48±4.09 years. All patients were successfully discharged without complications such as coronary artery obstruction and pacemaker implantation, and the average transvalvular pressure gradient was 16.39±6.52 mm Hg before discharge. During the median follow-up time of 16 months, the left ventricular diastolic inner diameter and ejection fraction were continuously improved. ConclusionTranscatheter valve-in-valve using domestic self-expanding valves is safe and feasible to treat aortic bioprosthetic valve failure. Sound patient selection and surgical strategies are critical to achieve good hemodynamics.
Objective To summarize the short-term results of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) in the treatment of bioprosthetic valve failure after aortic valve replacement. Methods We reviewed the clinical data of patients who underwent ViV-TAVI from 2021 to 2022 in the First Affiliated Hospital of Zhengzhou University. The valve function was evaluated by echocardiography before operation, immediately after operation and 3 months after operation. The all-cause death and main complications during hospitalization were analyzed. Results A total of 13 patients were enrolled, including 8 males and 5 females with a mean age of (65.9±8.5) years, and the interval time between aortic valve replacement and ViV-TAVI was (8.5±3.4) years. The Society of Thoracic Surgeons mortality risk score was 10.3%±3.2%. None of the 13 patients had abnormal valve function after operation. The mean transvalvular pressure gradient of aortic valve was decreased (P<0.001), the peak flow velocity of aortic valve was decreased (P<0.001), and the left ventricular ejection fraction was not changed significantly (P=0.480). There were slight perivalvular leakage in 2 patients and slight valve regurgitation in 3 patients. Three months after operation, the mean transvalvular pressure difference and peak flow velocity of aortic valve in 12 patients were significantly decreased compared with those before operation (P≤0.001). Conclusion This study demonstrates that ViV-TAVI for the treatment of bioprosthetic valve failure after aortic valve replacement is associated with favorable clinical and functional cardiovascular benefits, the short-term results are satisfactory.
ObjectiveTo discuss the operation skill and clinical effects of using domestic balloon-expandable Prizvalve® transcatheter "valve-in-valve" to treat the degenerated bioprosthesis in the tricuspid position.MethodsAll the admitted surgical tricuspid valve bioprosthetic valve replacement patients were evaluated by computerized tomography angiography (CTA), ultrasound, and 3D printing technology, and 2 patients with a degenerated bioprosthesis were selected for tricuspid valve "valve-in-valve" operation. Under general anesthesia, the retro-preset Prizvalve® system was implanted into degenerated tricuspid bioprosthesis via the femoral vein approach under the guidance of transesophageal echocardiographic and fluoroscopic guidance.ResultsTranscatheter tricuspid valve implantation was successfully performed in both high-risk patients, and tricuspid regurgitation disappeared immediately. The operation time was 1.25 h and 2.43 h, respectively. There was no serious complication in both patients, and they were discharged from the hospital 7 days after the operation.ConclusionThe clinical effect of the degenerated tricuspid bioprosthetic valve implantation with domestic balloon-expandable valve via femoral vein approach "valve-in-valve" is good. Multimodality imaging and 3D printing technology can safely and effectively guide the implementation of this innovative technique.
“Valve-in-valve” technique is an effective method to treat the bioprosthesis structural valve degeneration. In this paper, an 82-year-old male patient with severe aortic valve regurgitation had underwent surgical aortic valve replacement. He had a bioprosthesis structural valve degeneration which caused severe aortic stenosis more than 3 years after surgery. His symptoms of chest distress and short breath were aggravated progressively, and not relieved by conventional treatment. As the deterioration in his unstabled circulation system, an emergency transcatheter aortic valve replacement was conducted for him. The operation was finally successful, the symptoms were relived significantly after operation, and then the follow-up indicated that he had a good recovery.