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Transcatheter Treatment Of Failed Mitral Valve Repair And Deteriorated Bioprosteses
Gry Dahle, Arnt Fiane, Lars Aaberge, Bjørn Bendz, Jon T. Offstad, Jan Fredrik Bugge, Jan Hovdenes, Kjell Arne Rein.
Rikshospitalet, OUS, Oslo, Norway.

OBJECTIVE: Redo surgery in patients with failed valve repair or with deteriorated surgical bioprosteses is often challenging. In those pateients transcathater valve implantation may be an easier option and of benefit, especially if there are additional comorbidities and open coronary bypass artery grafting. This singel center presentation elucidate various, some still off labell, new transcatheter valve (THV) applications.
METHODS: Tvelve patients, five men, with mean age 72 years (44-83) were included. Mean logistic Euroscore was 26 (10-48) and ejection fraction was mean 38 (15-45). Six patients had undergone additional CABG, two patietns were in hemodialysis and three patients had prior pacemaker/ICD implanted. Two patients underwent transcatheter treatment following failed mital valve annuloplasty (one regurgitation/one stenosis), nine patients following deteriorated bioprostheses in mitral (n=1), aortic (n=6) tricuspidal (n=1) and tricuspdal/pulmonal (n=1) position and one patient following paravalvular leak in an implanted catheter valve. The access was either transfemoral, transapical or transatrial. Edwards SAPIEN (Edwards Lifesciences, Irvine,CA) was used in all except for two patients who had one CoreValve (Medtronic inc. Minneapolis, MN) and one Engager (Medtronic inc, Minneapolis, MN) implanted. Partial femoro-femoral bypass was used in two patients.
RESULTS: The procedural success was 92 %, one patient underwent open surgery due to paravalvualr leak. Three patients with the smalles valves had initially acceptable pressure gradients, upon three month follow up the gradients had incresed to 45mmHg. Two patients needed femoral artery.reconstruction. Early mortality was 1/12 (8 %) and total mortality was 2/12 (16 %).
CONCLUSIONS: Our results demonstrate the feasibility of transcatheter heart valve treatment for failed surgical valve repair and deteriorated bioprostheses in all positions, for stenosis as well as regurgitation. The appropriate accessroute and most suitable catheter valve must be choosen in each case. Maybe for the smallest valves (< 23 mm) valve-in-valve should not be done, at least not with the Edwards Sapien XT. In the future this may play a significant role for the stategy in redo valve surgery.

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