Emergency Transthoracic Transapical Mitral Valve-in-Valve Implantation

Objectives: The valve-in-valve (VIV) technique is an emerging therapeutic option for patients with failure of previously implanted xenografts. We describe a balloon-expandable transthoracic transapical mitral VIV implantation in an emergency setting in a 69-year-old woman with dysfunction of the mitral bioprosthesis. Methods: Left ventricular apical access was applied. After balloon valvuloplasty, a 26-mm Edwards-Sapien transcatheter valve (Edwards Lifesciences LLC, Irvine, CA, USA) was deployed within the mitral xenograft, using rapid ventricular pacing. Results: The transcatheter valve functioned properly postoperatively and three-dimensional echocardiography carried out 1 month later showed a well-functioning VIV prosthesis and no mitral stenosis (mitral valve area 3 cm(2), mean gradient 3 mmHg). Conclusions: In this patient, VIV implantation was found to be a safe alternative to an emergent valve replacement. It might represent a suitable option to conventional procedures even among lower risk patients. (J Interven Cardiol 2011; 24:474-476)