Clinical efficacy of valve-in-valve transcatheter mitral valve replacement for degenerated mitral surgical bioprostheses_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Shixiong , HAN Xu , ZHENG Zhikun , ZHANG Yongkai ,  XU Jing ,  HUANG Chen

Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, P. R. China;

Corresponding?author：

XU Jing, Email: fccxuj@zzu.edu.cn; HUANG Chen, Email: fcchuangc@zzu.edu.cn

Keywords：

Valve-in-valve transcatheter mitral valve replacement; degenerated bioprosthetic valve; mitral valve replacement; clinical outcomes

DOI：

10.7507/1007-4848.202410045

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the clinical efficacy of valve-in-valve transcatheter mitral valve replacement for the management of degenerated bioprosthetic mitral valves. Methods This study retrospectively analyzed the clinical data of patients who underwent transcatheter mitral valve replacement due to degenerated bioprosthetic mitral valves at the First Affiliated Hospital of Zhengzhou University from 2020 to 2023. The analysis included baseline characteristics, surgical details, perioperative complications, and hemodynamic changes during the early postoperative period and subsequent follow-up. Results A total of 31 patients were included in the study, comprising 7 males and 24 females, with an average age of (66.57±9.32) years. The average duration since the initial surgical placement of the bioprosthetic valves was (9.92±3.71) years. The procedures included 7 patients utilizing the transfemoral venous-atrial septal approach and 24 patients employing the transapical approach. All patients exhibited significant improvement in cardiac function postoperatively, with a reduction in the number of patients classified as New York Heart Association (NYHA) grade Ⅲ or Ⅳ and those with moderate to severe tricuspid valve regurgitation. Echocardiographic assessments revealed a decrease in peak flow velocity across the mitral valve and a reduction in the average transvalvular pressure gradient, while left ventricular ejection fraction remained unchanged. One patient experienced a recurrent stroke and died on the fifth postoperative day; however, the remaining patients were discharged uneventfully, without complications such as cardiac death, left ventricular outflow tract obstruction, or pacemaker implantation. During a median follow-up period of 12 months, no adverse events were reported, and hemodynamic stability was maintained. Conclusion Valve-in-valve transcatheter mitral valve replacement is a safe and effective option for patients with degenerated bioprosthetic mitral valves, demonstrating favorable hemodynamic outcomes and satisfactory short-term clinical results.

Citation： WU Shixiong, HAN Xu, ZHENG Zhikun, ZHANG Yongkai, XU Jing, HUANG Chen. Clinical efficacy of valve-in-valve transcatheter mitral valve replacement for degenerated mitral surgical bioprostheses. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(8): 1252-1257. doi: 10.7507/1007-4848.202410045 Copy

1.	張海波, 潘湘斌, 郭應強, 等. 中國心臟二尖瓣生物瓣毀損介入瓣中瓣技術多中心專家建議[J]. 中國胸心血管外科臨床雜志, 2024, 31(8): 1090-1095.Zhang HB, Pan XB, Guo YQ, et al. Multicenter expert recommendations on interventional valve-in-valve technology for mitral bioprosthetic valve destruction in China[J]. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(8): 1090-1095.
2.	Zogg CK, Hirji SA, Percy ED, et al. Comparison of postdischarge outcomes between valve-in-valve transcatheter mitral valve replacement and reoperative surgical mitral valve replacement[J]. Am J Cardiol, 2023, 201: 200-210.
3.	Cheung A, Webb JG, Wong DR, et al. Transapical transcatheter mitral valve-in-valve implantation in a human[J/OL]. Ann Thorac Surg, 2009, 87(3): e18-e20. DOI: 10.1016/j.athoracsur.2008.10.016.
4.	Mack M, Carroll JD, Thourani V. Transcatheter mitral valve therapy in the United States: a report from the STS-ACC TVT registry[J]. J Am Coll Cardiol, 2021, 78(23): 2326-2353.
5.	Malaisrie SC, Guerrero M, Davidson C, et al. One-year outcomes of transseptal mitral valve-in-valve in intermediate surgical risk patients[J/OL]. Circ Cardiovasc Interv, 2024, 17(8): e013782. DOI: 10.1161/CIRCINTERVENTIONS.123.013782.
6.	張海波, 孟旭, 王勝洵, 等. 經導管二尖瓣生物瓣毀損的瓣中瓣治療技術[J]. 中華胸心血管外科雜志, 2019, 35(6): 331-333.Zhang HB, Meng X, Wang SX, et al. Transcatheter valve in valve implantation treatment for the mitral bioprothesis deterioration[J]. Chin J Clin Thorac Cardiovasc Surg, 2019, 35(6): 331-333.
7.	劉光輝, 馮德廣, 王佳祥, 等. 二尖瓣生物瓣毀損行介入瓣中瓣的早期效果分析[J]. 臨床心血管病雜志, 2023, 39(1): 39-44.Liu GH, Feng DG, Wang JX, et al. The early outcomes of transcatheter valve-in-valve implantation treatment for mitral bioprosthetic valve dysfunction[J]. J Clin Cardiol (China), 2023, 39(1): 39-44.
8.	車波, 宋丹, 徐承義. 經導管瓣中瓣技術在二尖瓣生物瓣衰敗中應用的臨床現狀[J]. 中國心血管病研究, 2022, 20(5): 476-480.Che B, Song D, Xu CY. Clinical status of transcatheter valve-in-valve replacement in the treatment of mitral bioprosthetic valve failure[J]. Chin J Cardiovasc Res, 2022, 20(5): 476-480.
9.	Tzimas G, Haugan D, Akodad M, et al. Computed tomography reference dimensions for identification of stented surgical mitral bioprostheses valve size[J]. J Cardiovasc Comput Tomogr, 2022, 16(6): 517-523.
10.	Shivaraju A, Michel J, Frangieh AH, et al. Transcatheter aortic and mitral valve-in-valve implantation using the Edwards Sapien 3 heart valve[J/OL]. J Am Heart Assoc, 2018, 7(14): e007767. DOI: 10.1161/JAHA.117.007767.
11.	Yoon SH, Whisenant BK, Bleiziffer S, et al. Transcatheter mitral valve replacement for degenerated bioprosthetic valves and failed annuloplasty rings[J]. J Am Coll Cardiol, 2017, 70(9): 1121-1131.
12.	Tsuruta H, Hayashida K, Yashima F, et al. Incidence, predictors, and midterm clinical outcomes of left ventricular obstruction after transcatheter aortic valve implantation[J/OL]. Catheter Cardiovasc Interv, 2018, 92(4): e288-e298. DOI: 10.1002/ccd.27508.
13.	Khan JM, Babaliaros VC, Greenbaum AB, et al. Anterior leaflet laceration to prevent ventricular outflow tract obstruction during transcatheter mitral valve replacement[J]. J Am Coll Cardiol, 2019, 73(19): 2521-2534.
14.	Whisenant B, Kapadia SR, Eleid MF, et al. One-year outcomes of mitral valve-in-valve using the SAPIEN 3 transcatheter heart valve[J]. JAMA Cardiol. 2020; 5(11): 1245-1252.
15.	Jimenez-Diaz VA, Kapadia SR, Linke A, et al. Cerebral embolic protection during transcatheter heart interventions[J]. EuroIntervention, 2023, 19(11): 549-570.
16.	Kapadia SR, Makkar R, Leon M, et al. Cerebral embolic protection during transcatheter aortic-valve replacement[J]. N Engl J Med, 2022, 387(14): 1253-1263.
17.	張靖男, 萬俊義, 宋會軍, 等. 經導管 "瓣中瓣" 置換術治療二尖瓣置換術后生物瓣衰敗的療效評價[J]. 中國循環雜志, 2023, 38(2): 165-170.Zhang JN, Wan JY, Song HJ, et al. Clinical efficacy of transcatheter mitral valve-in-valve replacement in patients with degenerated bioprosthesis[J]. Chin Circ J, 2023, 38(2): 165-170.
18.	Agarwal V, Kaple RK, Mehta HH, et al. Current state of transcatheter mitral valve implantation in bioprosthetic mitral valve and in mitral ring as a treatment approach for failed mitral prosthesis[J]. Ann Cardiothorac Surg, 2021, 10(5): 585-604.
19.	Gallo M, Sá MPBO, Doulamis IP, et al. Transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic and mitral valves–an update on indications, techniques, and clinical results[J]. Expert Review of Medical Devices, 2021, 18(7): 597-608.
20.	楊杰, 王斌, 陳翔, 等. 經導管行二尖瓣生物瓣毀損并重度主動脈瓣狹窄雙瓣置換1例[J]. 中國介入心臟病學雜志, 2022, 30(3): 235-237.Yang J, Wang B, Chen X, et al. A case of transcatheter biologic mitral valve destruction and severe aortic stenosis with double valve replacement[J]. Chin J Interv Cardiol, 2022, 30(3): 235-237.
21.	中國醫師協會心血管分會結構性心臟病學組. 結構性心臟病介入治療2023年度報告精要[J]. 中國介入心臟病學雜志, 2024, 32(3): 121-135.Structural Cardiology Committee of Cardiovascular Physicians Branch of Chinese Medical Doctor Association. Annual report on interventional therapy for structural heart disease in 2023[J]. Chin J Interv Cardiol, 2024, 32(3): 121-135.

1. 張海波, 潘湘斌, 郭應強, 等. 中國心臟二尖瓣生物瓣毀損介入瓣中瓣技術多中心專家建議[J]. 中國胸心血管外科臨床雜志, 2024, 31(8): 1090-1095.Zhang HB, Pan XB, Guo YQ, et al. Multicenter expert recommendations on interventional valve-in-valve technology for mitral bioprosthetic valve destruction in China[J]. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(8): 1090-1095.
2. Zogg CK, Hirji SA, Percy ED, et al. Comparison of postdischarge outcomes between valve-in-valve transcatheter mitral valve replacement and reoperative surgical mitral valve replacement[J]. Am J Cardiol, 2023, 201: 200-210.
3. Cheung A, Webb JG, Wong DR, et al. Transapical transcatheter mitral valve-in-valve implantation in a human[J/OL]. Ann Thorac Surg, 2009, 87(3): e18-e20. DOI: 10.1016/j.athoracsur.2008.10.016.
4. Mack M, Carroll JD, Thourani V. Transcatheter mitral valve therapy in the United States: a report from the STS-ACC TVT registry[J]. J Am Coll Cardiol, 2021, 78(23): 2326-2353.
5. Malaisrie SC, Guerrero M, Davidson C, et al. One-year outcomes of transseptal mitral valve-in-valve in intermediate surgical risk patients[J/OL]. Circ Cardiovasc Interv, 2024, 17(8): e013782. DOI: 10.1161/CIRCINTERVENTIONS.123.013782.
6. 張海波, 孟旭, 王勝洵, 等. 經導管二尖瓣生物瓣毀損的瓣中瓣治療技術[J]. 中華胸心血管外科雜志, 2019, 35(6): 331-333.Zhang HB, Meng X, Wang SX, et al. Transcatheter valve in valve implantation treatment for the mitral bioprothesis deterioration[J]. Chin J Clin Thorac Cardiovasc Surg, 2019, 35(6): 331-333.
7. 劉光輝, 馮德廣, 王佳祥, 等. 二尖瓣生物瓣毀損行介入瓣中瓣的早期效果分析[J]. 臨床心血管病雜志, 2023, 39(1): 39-44.Liu GH, Feng DG, Wang JX, et al. The early outcomes of transcatheter valve-in-valve implantation treatment for mitral bioprosthetic valve dysfunction[J]. J Clin Cardiol (China), 2023, 39(1): 39-44.
8. 車波, 宋丹, 徐承義. 經導管瓣中瓣技術在二尖瓣生物瓣衰敗中應用的臨床現狀[J]. 中國心血管病研究, 2022, 20(5): 476-480.Che B, Song D, Xu CY. Clinical status of transcatheter valve-in-valve replacement in the treatment of mitral bioprosthetic valve failure[J]. Chin J Cardiovasc Res, 2022, 20(5): 476-480.
9. Tzimas G, Haugan D, Akodad M, et al. Computed tomography reference dimensions for identification of stented surgical mitral bioprostheses valve size[J]. J Cardiovasc Comput Tomogr, 2022, 16(6): 517-523.
10. Shivaraju A, Michel J, Frangieh AH, et al. Transcatheter aortic and mitral valve-in-valve implantation using the Edwards Sapien 3 heart valve[J/OL]. J Am Heart Assoc, 2018, 7(14): e007767. DOI: 10.1161/JAHA.117.007767.
11. Yoon SH, Whisenant BK, Bleiziffer S, et al. Transcatheter mitral valve replacement for degenerated bioprosthetic valves and failed annuloplasty rings[J]. J Am Coll Cardiol, 2017, 70(9): 1121-1131.
12. Tsuruta H, Hayashida K, Yashima F, et al. Incidence, predictors, and midterm clinical outcomes of left ventricular obstruction after transcatheter aortic valve implantation[J/OL]. Catheter Cardiovasc Interv, 2018, 92(4): e288-e298. DOI: 10.1002/ccd.27508.
13. Khan JM, Babaliaros VC, Greenbaum AB, et al. Anterior leaflet laceration to prevent ventricular outflow tract obstruction during transcatheter mitral valve replacement[J]. J Am Coll Cardiol, 2019, 73(19): 2521-2534.
14. Whisenant B, Kapadia SR, Eleid MF, et al. One-year outcomes of mitral valve-in-valve using the SAPIEN 3 transcatheter heart valve[J]. JAMA Cardiol. 2020; 5(11): 1245-1252.
15. Jimenez-Diaz VA, Kapadia SR, Linke A, et al. Cerebral embolic protection during transcatheter heart interventions[J]. EuroIntervention, 2023, 19(11): 549-570.
16. Kapadia SR, Makkar R, Leon M, et al. Cerebral embolic protection during transcatheter aortic-valve replacement[J]. N Engl J Med, 2022, 387(14): 1253-1263.
17. 張靖男, 萬俊義, 宋會軍, 等. 經導管 "瓣中瓣" 置換術治療二尖瓣置換術后生物瓣衰敗的療效評價[J]. 中國循環雜志, 2023, 38(2): 165-170.Zhang JN, Wan JY, Song HJ, et al. Clinical efficacy of transcatheter mitral valve-in-valve replacement in patients with degenerated bioprosthesis[J]. Chin Circ J, 2023, 38(2): 165-170.
18. Agarwal V, Kaple RK, Mehta HH, et al. Current state of transcatheter mitral valve implantation in bioprosthetic mitral valve and in mitral ring as a treatment approach for failed mitral prosthesis[J]. Ann Cardiothorac Surg, 2021, 10(5): 585-604.
19. Gallo M, Sá MPBO, Doulamis IP, et al. Transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic and mitral valves–an update on indications, techniques, and clinical results[J]. Expert Review of Medical Devices, 2021, 18(7): 597-608.
20. 楊杰, 王斌, 陳翔, 等. 經導管行二尖瓣生物瓣毀損并重度主動脈瓣狹窄雙瓣置換1例[J]. 中國介入心臟病學雜志, 2022, 30(3): 235-237.Yang J, Wang B, Chen X, et al. A case of transcatheter biologic mitral valve destruction and severe aortic stenosis with double valve replacement[J]. Chin J Interv Cardiol, 2022, 30(3): 235-237.
21. 中國醫師協會心血管分會結構性心臟病學組. 結構性心臟病介入治療2023年度報告精要[J]. 中國介入心臟病學雜志, 2024, 32(3): 121-135.Structural Cardiology Committee of Cardiovascular Physicians Branch of Chinese Medical Doctor Association. Annual report on interventional therapy for structural heart disease in 2023[J]. Chin J Interv Cardiol, 2024, 32(3): 121-135.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy of valve-in-valve transcatheter mitral valve replacement for degenerated mitral surgical bioprostheses

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content