Transcatheter access route options for treatment of degenerated mitral valve prosthesis with a balloon-expandable biological valve

Abstract

Objectives There is an ongoing discussion if valve-in-valve implantations into failing mitral xenografts should be performed only via a transapical approach. Background In selected high-risk patients, transcatheter valve implantation is an emerging therapy for degenerated mitral xenografts in need of repeated valve replacement. Methods Here we describe three different strategies to treat a failing mitral biological prosthesis (Carpentier Edwards S.A.V) by implantation of a SAPIEN-XT valve, which was performed in three different patients. As access site, a transjugular/transseptal approach, a transfemoral/transseptal approach, and a transapical approach were chosen. Results With all three approaches, valve-in-valve implantation was successfully achieved. The acute hemodynamic effects were excellent and according to VARC there was no adverse event recorded during a 6 months follow-up. Conclusions Feasibility of all three approaches is demonstrated and might be taken into consideration for treatment in various patients. © 2012 Wiley Periodicals, Inc. Copyright © 2012 Wiley Periodicals, Inc.