AUTHOR=Schamroth Pravda Nili , Mishaev Raffael , Levi Amos , Witberg Guy , Shapira Yaron , Orvin Katia , Barkan Yeela Talmor , Hamdan Ashraf , Sharoni Ram , Perl Leor , Sagie Alexander , Assa Hana Vaknin , Kornowski Ran , Codner Pablo 

TITLE=Five-Year Outcomes of Patients With Mitral Structural Valve Deterioration Treated With Transcatheter Valve in Valve Implantation – A Single Center Prospective Registry

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.883242

DOI=10.3389/fcvm.2022.883242

ISSN=2297-055X

ABSTRACT=The Valve-in-Valve (ViV) technique is an emerging alternative for the treatment of bioprosthetic structural valve deterioration (SVD) in the mitral position. We report on intermediate-term outcomes of patients with symptomatic SVD in the mitral position who were treated by transcatheter mitral valve-in-valve (TM-ViV) implantation during the years 2010-2019 in our center. Three main outcomes were examined during the follow-up period: NYHA functional class, TM-ViV hemodynamic data per echocardiography, and mortality. Our cohort consisted of 49 patients (mean age 77.4+-10.5 years, 65.3% female). The indications for TM-ViV were mainly for regurgitant pathology (77.6%). All 49 patients were treated with a balloon-expandable device. The procedure was performed via transapical access in 17 cases (34.7%) and transfemoral vein / trans-atrial septal puncture in 32 cases (65.3%). Mean follow-up was 4.4 ± 2.0 years. 98% and 91% of patients were in NYHA I/II at 1 and 5 years respectively. Mitral regurgitation was ≥ moderate in 86.3% of patients prior to the procedure and this decreased to 0% (p<0.001) following the procedure and was maintained over 2 years follow-up. The mean   trans-mitral valve gradients decreased from pre-procedural values of 10.1± 5.1mmHg to 
7.0 ±2.4mmHg at one month following the procedure (p=0.03). Mortality at one year was 16% (95%, CI 5-26) and 35% (95%, CI 18-49) at 5 years. ViV in the mitral position offers an effective and durable treatment option for patients with SVD at high surgical risk.