Transcatheter aortic and mitral valve implantations for failed bioprosthetic heart valves

Background: Restoring degenerated bioprosthetic valves by transcatheter valve implantation may obviate the need for redo surgery in carefully selected patients. We present our initial experience with valve-in-valve (VIV) procedures for failed aortic and mitral bioprosthetic valves. Methods: Data were collected for all patients who underwent VIV procedures at a tertiary medical center (n ≤ 6). Findings were analyzed and compared with those for transcatheter valve implantation in native valves at the same center during the last 3 years (n ≤ 84). Results: Six patients of mean age 78.3 ± 13.8 years (range, 51-87) underwent VIV procedures with the CoreValve (n ≤ 4) or Edwards-SAPIEN device (n ≤ 2). Four (66%) had a failed prosthetic aortic valve, and 2 (33%) had a failed prosthetic mitral valve. Regurgitation accounted for valve failure in 83.3% of the VIV group versus 1.2% of the comparison group (p < 0.001). Procedural success and 30-day survival rates were 100%. Patient functional class improved significantly from 0% class I/II, 50% class III, and 50% class IV before the procedure to 66% class I, 33% class II, and 0% class III/IV after (p < 0.001). Conclusion: This preliminary experience demonstrates that in carefully selected cases, transcathether valve implants can be safely and effectively deployed in stenotic and/or regurgitant degenerated bioprosthetic valves. Further evaluations in larger series are needed.