First colombian tricuspid endovascular valve in valve using kissing balloon technique for failed bioprosthesis annular cracking / El primer caso colombiano de reemplazo percutáneo válvula en válvula tricúspide utilizando la técnica de kissing balloon con fractura anular por falla bioprostética

Abstract We present the first case in Colombia of tricuspid endovascular valve in valve for failed bioprosthesis in a 40 years old patient with very high operative risk with great results, proposing kissing balloon annulus cracking technique as a practical solution for the colombian specialists.

Resumen Se presenta el primer caso en Colombia de un reemplazo percutáneo tipo válvula en válvula por falla de bioprótesis tricúspide en un paciente de 40 años con un muy alto riesgo quirúrgico, con excelentes resultados, proponiendo la técnica kissing balloon de fractura anular como una solución práctica para los especialistas colombianos.

Valve in valve en posición tricuspídea: reconociendo opciones de manejo para la válvula «olvidada¼ / Valve in valve in tricuspid position: recognizing management options for the "forgotten" valve

Resumen Presentamos el caso de una paciente con bioprótesis tricuspídea disfuncionante a quien se le realizó un implante valve in valve con una prótesis transcatéter SAPIEN XT, demostrando que esta técnica es una alternativa terapéutica válida frente a la reintervención de la válvula tricúspide.

Abstract We present the case of a patient who was implanted with a transcatheter prosthesis on a dysfunctional bioprosthesis, demonstrating that it is a valid therapeutic alternative to reoperation in those patients with high surgical risk.

First Colombian tricuspid endovascular valve in valve using kissing balloon technique for failed bioprosthesis annular cracking / Primer valve in valve tricúspideo en Colombia usando la técnica Kissing Balloon para ruptura anular de la bioprótesis deteriorada

Abstract We present the first case in Colombia of tricuspid endovascular valve in valve for failed bioprosthesis in a 40-year-old patient with very high operative risk with great results, proposing kissing balloon annulus cracking technique as a practical solution for the Colombian specialists.

Resumen Presentamos el primer caso en Colombia de valve in valve tricúspideo para una bioprótesis deteriorada en una paciente de 40 años con muy alto riesgo quirúrgico con muy buenos resultados, y se propone la técnica de kissing balloon para ruptura anular como una solución practica para los especialistas en Colombia.

Transcatheter valve-in-valve implantation using the J-Valve for bioprosthetic degeneration at different anatomic positions: A single-center experience / 中国胸心血管外科临床杂志

@#Objective     To summarize the early results and clinical experience of using the J-Valve for transcatheter valve-in-valve implantation in patients with degenerated bioprosthesis at different anatomic positions. Methods     A retrospective analysis was conducted to evaluate the short-term outcomes of 39 consecutive patients who underwent transcatheter valve-in-valve implantation using the J-Valve System in the Department of Cardiac Surgery of Guangdong Provincial People’s Hospital from April 2020 to August 2021 due to bioprosthetic degeneration at different  anatomic positions. Among them, 35 patients underwent transcatheter mitral valve-in-valve (TMViV) implantation, 1 transcatheter aortic valve-in-valve (TAViV) implantation, 1 transcatheter tricuspid valve-in-valve (TTViV) implantation, 1 TMViV implantation with simultaneous TAViV implantation, and another one TMViV implantation with simultaneous transcatheter aortic valve replacement (TAVR) and perivalvular leakage (PVL) closure. Results     Among the 35 patients who underwent isolated TMViV implantation, 17 were male and 18 were female with a mean age of 72.6±10.8 years. Mean duration between two operations was 10.5±2.7 years. The mean Society of Thoracic Surgeons and EuroSCORE Ⅱ scores were 12.95%±9.61% and 13.91%±8.94%, respectively. The device success rate was 97.1% and no death occured during the operation. One patient was transferred to thoracotomy due to device displacement, 1 was re-opened for uncontrolled bleeding, and 1 presented left ventricular outflow tract obstruction. One patient underwent craniotomy due to intracranial hemorrhage within 30 days after surgery, and no other complications occurred including death, stroke, permanent pacemaker implantation, cardiac tamponade, or re-hospitalization. The mean follow-up time was 6.0±4.4 months, the mean mitral valve gradient was significantly improved (10.4±2.0 mm Hg vs. 5.5±1.2 mm Hg, P<0.05), and the New York Heart Association class≤Ⅱ in all the patients at the last follow-up. Among the other 4 patients who did not undergo isolated TMViV implantation, the transapical TAViV implantation and the trans-right atrium TTViV implantation were successful without intra- or post-operative complications. The patient who underwent TMViV and TAViV implantation simultaneously via transapical approach died of severe pulmonary hemorrhage and multiple organ failure 16 days after surgery. The other patient who underwent transapical TMViV combined with TAVR and PVL closure died of septic shock 10 days after the surgery. Conclusion     Transcatheter valve-in-valve implantation using the J-Valve system is shown to be a safe and effective procedure to treat mitral, aortic and tricuspid bioprosthetic valve dysfunction in high-risk patients, providing a new alternative to surgical surgery for degenerated bioprosthesis at different anatomic positions. However, simultaneous different valves intervention should be very cautious.

Un caso clínico de implante valve in valve mitral: nuevo horizonte en el tratamiento de la disfunción valvular protésica / A clinical case of mitral valve in valve implant: new skyline in the treatment of prosthetic valve dysfunction / Presentação de um caso clínico do valve in valve mitral: um novo horizonte no tratamento da disfunção valvular protética

La disfunción valvular protésica es cada vez más frecuente debido al envejecimiento de la población portadora de bioprótesis y se presenta como un desafío en el momento de su diagnóstico, valoración y tratamiento. Aplicar un enfoque imagenológico multimodal es fundamental para su manejo. Respecto al tratamiento, surge como nueva alternativa un procedimiento mínimamente invasivo de sustitución valvular percutánea, denominado valve in valve, principalmente en pacientes con riesgo quirúrgico elevado. Presentamos uno de los primeros casos locales de implante percutáneo de prótesis mitral transeptal dentro de una bioprótesis mitral quirúrgica disfuncionante.

Prosthetic valve dysfunction is increasingly common due to the aging of the bioprosthesis-bearing population, and it presents a challenge at the time of diagnosis, evaluation, and treatment. A multimodal imaging approach is essential for its management. In relation to treatment, a minimally invasive percutaneous valve replacement procedure called valve in valve arises as a new alternative, mainly in patients with high surgical risk. We present one of first local cases of percutaneous implantation of a transseptal mitral prosthesis within a dysfunctional surgical mitral bioprosthesis.

A disfunção valvular protética é cada vez mais comum devido ao envelhecimento da população portadora de biopróteses e representa um desafio no momento do diagnóstico, avaliação e tratamento. A multimodalidade da imagem cardiovascular é essencial para sua avaliação. Em relação ao tratamento, um procedimento de troca valvular percutânea minimamente invasivo, denominado valve in valve, surge como uma nova alternativa, principalmente em pacientes com alto risco cirúrgico. Apresentamos um dos primeiros casos realizados no Uruguai de implantação percutânea de prótese mitral transeptal dentro de bioprótese mitral cirúrgica disfuncional.

Preliminary exploration of the domestic balloon-expandable valve in the treatment of degenerated tricuspid bioprosthetic valve via transcatheter "valve-in-valve" technology / 中国胸心血管外科临床杂志

@#Objective    To discuss the operation skill and clinical effects of using domestic balloon-expandable Prizvalve® transcatheter "valve-in-valve" to treat the degenerated bioprosthesis in the tricuspid position. Methods    All the admitted surgical tricuspid valve bioprosthetic valve replacement patients were evaluated by computerized tomography angiography (CTA), ultrasound, and 3D printing technology, and 2 patients with a degenerated bioprosthesis were selected for tricuspid valve "valve-in-valve" operation. Under general anesthesia, the retro-preset Prizvalve® system was implanted into degenerated tricuspid bioprosthesis via the femoral vein approach under the guidance of transesophageal echocardiographic and fluoroscopic guidance. Results    Transcatheter tricuspid valve implantation was successfully performed in both high-risk patients, and tricuspid regurgitation disappeared immediately. The operation time was 1.25 h and 2.43 h, respectively. There was no serious complication in both patients, and they were discharged from the hospital 7 days after the operation. Conclusion    The clinical effect of the degenerated tricuspid bioprosthetic valve implantation with domestic balloon-expandable valve via femoral vein approach "valve-in-valve" is good. Multimodality imaging and 3D printing technology can safely and effectively guide the implementation of this innovative technique.

Transapical transcatheter valve-in-valve implantation treatment for patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement / 中国胸心血管外科临床杂志

@#Objective    To determine the clinical efficacy of transapical transcatheter mitral valve-in-valve treatment for patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement. Methods    The clinical data of 9 patients who underwent transapical transcatheter mitral valve-in-valve implantation after aortic-mitral double valve replacement due to mitral bioprosthesis deterioration from May 2020 to January 2021 in our hospital were retrospectively analyzed, including 4 males and 5 females with a mean age of 72.44±7.57 years. Results    Surgeries were performed successfully in all patients with no conversion to median sternotomy. The mean procedural time was 101.33±48.49 min, the mechanical ventilation time was 23.11±26.54 h, the ICU stay was 1.89±1.05 d and the postoperative hospital stay was 6.11±2.02 d. Residual mild mitral regurgitation was only observed in 1 patient. Only 1 patient needed postoperative blood transfusion. No major complications were observed in all patients. There was no death in postoperative 90 days. Conclusion    For patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement, transapical transcatheter mitral valve-in-valve implantation achieves good clinical results and effectively  improves the hemodynamics without increasing the risk of postoperative left ventricular outflow tract obstruction. The surgery is feasible and effective.

The 1-year follow-up results of intraprocedural valve-in-valve deployment for treatment of aortic regurgitation following transcatheter aortic valve replacement (TAVR) in a single center / 中国胸心血管外科临床杂志

@#Objective    To evaluate the efficiency and safety of intraprocedural valve-in-valve deployment for treatment of aortic regurgitation following transcatheter aortic valve replacement (TAVR). Methods    Consecutive patients (n=333) who diagnosed with severe aortic stenosis and underwent TAVR in Zhongshan Hospital affiliated to Fudan University from October 3rd, 2010 to April 21st, 2021 were included. There were 208 males and 125 females aged 76.0±7.0 years. There were 316 patients underwent simple TAVR (simple TAVR group) and 17 patients underwent intraprocedural valve-in-valve deployment following TAVR (valve-in-valve group). Their clinical and echocardiographic outcomes were evaluated and compared. Results    There was no significant difference between the two groups of patients at postoperative 30 d and 1 year in all-cause mortality (4.4% vs. 0, P=1.000; 6.3% vs. 0, P=1.000), incidence of pacemaker implantation (10.4% vs. 17.6%, P=1.000; 11.8% vs. 17.6%, P=1.000), incidence of ischemic stroke (1.3% vs. 0, P=1.000; 1.3%  vs. 0, P=1.000), mean trans-aortic pressure gradient (11.4±6.4 mm Hg vs. 8.9±4.9 mm Hg, P=0.099; 10.5±7.6 mm Hg vs. 11.2±5.2 mm Hg, P=0.432), left ventricular ejection fraction (62.0%±9.0% vs. 57.0%±12.0%, P=0.189; 63.0%±7.0% vs. 60.0%±8.0%, P=0.170), and incidence of mitral valve dysfunction (0.6% vs. 5.9%, P=1.000; 0.6% vs. 5.9%, P=1.000). Conclusion    It is feasible to treat perivalvular leakage with valve-in-valve technology in the procedure of TAVR, and the short and medium-term effects are satisfied.

Early outcomes of transapical mitral valve-in-valve procedure / 中华胸心血管外科杂志

Objective:To summarize the experience and early outcomes of transapical mitral valve-in-valve procedure with J-Valve in patients with bioprostheses degeneration.Methods:The clinical data of 29 patients who underwent mitral transcatheter valve-in-valve implantation with J-Valve from April 2020 to March 2021 were retrospectively analyzed. There were male 16 and female 13 patients with average age (72.0±11.6) years. Patients underwent previous mitral valve replacement with bioprostheses of Hancock Ⅱ in 17, Edwards SAV in 7, Edwards Perimount in 3, Balmedic in 1, Mosaic in 1. The size of mitral bioprostheses included 25 # for 8 patients, 27 # for 17 patients, and 29 # for other 4 patients. The operations were performed in the hybrid operation room. Under X-ray fluoroscopy and TEE monitoring, the retro-preseted J-valve was implanted into the mitral bioprosthetic valve via the intercostal space and apical puncture. Results:One patient was converted urgently to mediate sternotomy, and the transcatheter mitral valve was reset after opening left atrium on cardiopulmonary bypass due to the migration of transcatheter valve. twenty eight patients were successfully completed transcatheter mitral valve-in-valve procedure with technical success achieving in 96.6% . Among the 28 patients who successfully were completed valve-in-valve procedure, 1 died and 27 were discharged in well condition. The mean mitral transvalvular gradient was (7.6±2.2)mmHg(1 mmHg=0.133 kPa), no death or other major complications occurred during the follow-up.Conclusion:The application of J-Valve interventional valve in patients with bioprosthesis degeneration can achieve favourable early outcomes, even if the patient was replaced with a small bioprosthesis in the previous operation, the hemodynamic effect was still satisfactory.

Valve in Valve transcatheter mitral valve replacement by a transvenous, transseptal access: A case report / 中国胸心血管外科临床杂志

@#Reoperation due to degenerated bioprostheses is an important factor of high-risk thoracic surgeries. In 2020 ACC/AHA guideline, Valve in Valve (ViV) was recommended for high-risk patient instead of surgical mitral valve replacement. This report described a 77-year-old male patient with a failed mitral bioprosthetic valve, evaluated at high risk of surgery, received a transvenous, transseptal transcatheter mitral valve replacement (TMVR). Tracheal intubation was removed at CCU 3 h after surgery without discomfort such as polypnea. The patient was transferred out of the CCU and discharged on the 3rd day. Compared with transapical access, transvenous transseptal access was less invasive, with shorter duration in CCU and hospitalization.

Nursing experience of a case of transcatheter aortic valve-in-valve replacement for prior bioprosthetic valve failure / 中国实用护理杂志

Objective@#To summarize nursing experience of transcatheter aortic valve-in-valve replacement performed on a patient with bioprosthetic valve failure.@*Methods@#To review nursing keypoints of a case of transcatheter aortic valve-in-valve replacement, including preoperative preparation, intraoperative care, monitor, valve preparation, and prejudgments of complications.@*Results@#The result of the surgical procedure was satisfactory by means of multidisciplinary teamwork. The patient was discharged 7 days after surgery without occurrence of perioperative complications.@*Conclusions@#A satisfactory result of transcatheter aortic valve-in-valve replacement procedure could be yielded by adequate preoperative preparation, mature notion for hybrid technique, strict monitor, and prevention for complications.

Tricuspid valve-in-valve procedure: a step-by-step guideline / Valve-in-valve tricúspide una guía paso a paso

Abstract Objective: The aim of this study was to present a valve-in-valve (ViV) case and a step-by-step guideline on how to perform this procedure. Methods: A 51-year-old female with a history of rheumatic heart disease and tricuspid valve replacement presented functional class deterioration, a transesophageal echocardiogram (TEE) revealed prosthetic dysfunction due to thrombosis; therefore, a valvular replacement with a 27 mm bioprosthesis (Carpentier-Edwards Perimount) was performed without complication. 3 years after the procedure, the patients presented functional class deterioration (NYHA-III) with tricuspid dysfunction by TEE and the heart team decided to perform a transcatheter tricuspid ViV replacement.

Resumen Objetivo: El objetivo de este artículo es presentar un caso clínico de un paciente en el cual se realizó el procedimiento valve-in-valve (ViV) en la válvula tricúspide junto con una guía de cómo llevar a cabo este procedimiento paso a paso. Metodología: Paciente femenino de 51 años de edad con antecedente de Cardiopatía Reumática presenta deterioro en clase funcional encontrándose por ecocardiografía transesofágica (ETE) disfunción de válvula protésica tricúspide secundario a trombosis, se realiza recambio valvular con prótesis biológica 27 mm (Carpentier Edwards Perimount) sin complicación. 3 años después, presenta deterioro de la clase funcional (NYHA-III) y se evidencia en ETE disfunción protésica tricúspide por lo cual se decide realizar un reemplazo ViV tricúspide transcatéter.

Transcatheter valve in valve implantation treatment for the mitral bioprothesis deterioration / 中华胸心血管外科杂志

Objective To explore the clinic results of our new designed transcatheter valve in valve for the mitral biopro-thesis deterioration.Methods Mitral bioprothesis deterioration patients with high risk for the routine bypass surgery got con-sent.After general anesthesia in the hybrid operation the left ventricle apical puncture was performed with guidance of 3D echo and X-ray.The retro-preset J Valve system was guided into the left atrium and the mitral bioprothesis with the beating heart . Results There were total 9 cases between Jan 2019 to Mar 2019 which had STS score above 6-8.The mitral bioprothesis in-cluded Hancock valve 3 cases, Perimount valve 3 cases, Epic valve 2 cases, Baxiter valve 1 case.The mitral bioprosthesis size included 27 for 6 cases and 25 for 3 cases.The successful implant rate was 100％, mortality rate 0, and all the patients recov-ered well without any main complications.The mean tran-valular pressure was only(8 ±2) mmHg (1 mmHg=0.133 kPa). Conclusion This innovative mitral valve in valve technique with retro-preset J Valve system got very good clinic results and worthy of deep research.

Perioperative management of transcatheter, aortic and mitral, double valve-in-valve implantation during pregnancy through left ventricular apical approach

Pregnant women with stenotic degeneration of bioprosthetic cardiac valves may require another valve replacement procedure when their symptoms deteriorate with progression of pregnancy, but fetal mortality is higher with cardiac surgery done on cardiopulmonary bypass. Transcatheter valve-in-valve implantation may help to improve the fetal and maternal outcomes in these situations. Double valve-in-valve implantation is rare and has not been reported in a pregnant patient. We report, for the first time, the case of a pregnant woman with stenotic bioprosthetic valves in the mitral and aortic positions, who underwent a successful concomitant, transcatheter, double valve-in-valve implantation through the left ventricular apical route during the second trimester of her precious pregnancy.

Implante de válvulas transcatéter en prótesis valvulares quirúrgicas disfuncionantes: un cambio de paradigma / Transcatheter valve implantation in dysfunctioning surgical valvular prostheses: a paradigm shift

La disfunción de las bioprótesis quirúrgicas frecuentemente ocurre en pacientes añosos, con severas comorbilidades, lo que implica un riesgo elevado frente a una nueva cirugía valvular. El implante de válvulas transcatéter dentro de bioprótesis disfuncionantes o procedimiento valve in valve (VIV), ha sido desarrollado como una nueva alternativa terapéutica para este tipo de situación. Los procedimientos VIV deben ser considerados para pacientes con disfunción protésica severa sintomática con alto riesgo quirúrgico, luego de un exhaustivo análisis individualizado por un grupo de expertos o heart team. La selección y evaluación previa de los pacientes son fundamentales para el éxito del procedimiento. La evidencia respalda más fuertemente este tipo de intervención en posición aórtica que en posición mitral. En esta revisión analizamos brevemente las indicaciones, la evaluación previa de los pacientes, los aspectos relevantes del procedimiento y sus complicaciones eventuales, con especial énfasis en el procedimiento VIV mitral, que ha sido motivo de dos recientes reportes de casos en esta revista.

Bioprosthetic surgical valve dysfunction occurs frequently in elderly patients with severe comorbidities, which implies a high surgical risk in case of redo valve surgery. Transcatheter valve implantation within a surgical bioprosthesis, so-called valve in valve procedure (VIV), has been developed as new treatment option for this situation. VIV procedures should be considered in patients with severely symptomatic prosthetic valve dysfunction with high surgical risk, after careful heart team evaluation. Patient selection and pre-procedural evaluation are mainstay for procedural success. Current evidence has stronger support for VIV procedure in aortic than in mitral position. In this review, we briefly analyze VIV procedure indications, patient evaluation, as well as relevant aspects of the procedure itself and its most frequent complications. Special emphasis will be given for VIV in mitral position which has been the focus of two recent case reports in this journal.

Transcatheter transapical mitral valve-in-valve implantation: case report / Implantación transapical transcatéter de válvula protésica mitral (valve-in-valve): reporte de caso

Abstract: Introduction: The transcatheter mitral valve replacement has recently emerged as a new therapeutic tool in the field of structural interventionism, the experience is in an early stage of development and previously was nonexistent in our country. Case report: Woman of 85 years old, with mitral and aortic valve replacement with biological prosthesis 9 years ago, progresive deterioration of functional class, mitral dysfunction by pannus, with very high surgical risk, transcatheter transapical mitral "valve-in-valve" implantation is performed, being successful, with total remission of symptoms. Conclusions: This procedure can be performed with minimal morbidity and low mortality, clinical and hemodynamic results are favorable in the short and medium term, this is the first case reported in Mexico.

Resumen: Introducción: La sustitución de la válvula mitral percutánea ha surgido recientemente como una nueva herramienta terapéutica en el campo del intervencionismo estructural, la experiencia está en una etapa temprana de desarrollo y anteriormente era inexistente en nuestro país. Caso clínico: Mujer de 85 años de edad, con reemplazo valvular aórtico y mitral, con prótesis biológica hace nueve años, con deterioro progresivo de clase funcional. La mitral con disfunción de pannus, con muy alto riesgo quirúrgico. Se lleva a cabo la implantación mitral transapical transcatéter (valve-in-valve), exitosamente, con remisión total de síntomas. Conclusiones: Este procedimiento se puede realizar con una mínima morbilidad y baja mortalidad, los resultados clínicos y hemodinámicos son favorables en el corto y mediano plazos, este es el primer caso reportado en México.