Original articleAdult cardiacTransapical Transcatheter Valve-in-Valve Implantation for Deteriorated Mitral Valve Bioprostheses
Section snippets
Patients and Study Design
Since November 2008, 301 patients were treated at our heart center with transapical transcatheter valve implantation. Seven patients within this cohort presented with a deteriorated mitral valve bioprosthesis. Patients' median age was 79 years with an interquartile range from 75 to 81 years. Two patients were male. For risk estimation, The Society of Thoracic Surgeons score and the European System for Cardiac Operative Risk (EuroSCORE) were used. The evaluated Society of Thoracic Surgeons score
Preoperative Data and Medical History
Patients were characterized by incidence of comorbidities and consecutive high procedural risk for conventional reoperative mitral valve surgery. One patient (number 6) presented with a porcelain aorta on top of other reported comorbidities and was most suitable for TAMVI. Active endocarditis was ruled out by laboratory findings and echocardiography in all patients. Table 1 summarizes relevant patient characteristics and reported comorbidities.
Preoperative Echocardiographic Findings
Patients presented with a severely degenerated
Comment
The establishment of catheter-based valve implantation has led to profound changes in the treatment of valvular heart disease in high-risk patients [1]. At the same time, biologic tissue-based prostheses have increasingly outperformed mechanical valves. There is an increased use of these bioprostheses even within the younger patient population [3]. The number of patients with a degenerated bioprosthesis in need for reoperation will rise because of these facts and an increase in life expectancy.
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These authors contributed equally to this work.