Transcatheter Access Route Options for Treatment of Degenerated Mitral Valve Prosthesis With a Balloon-Expandable Biological Valve

ObjectivesThere is an ongoing discussion if valve-in-valve implantations into failing mitral xenografts should be performed only via a transapical approach. BackgroundIn selected high-risk patients, transcatheter valve implantation is an emerging therapy for degenerated mitral xenografts in need of repeated valve replacement. MethodsHere 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. ResultsWith 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. ConclusionsFeasibility of all three approaches is demonstrated and might be taken into consideration for treatment in various patients. (c) 2012 Wiley Periodicals, Inc.