Clinical efficacy of transcatheter valve-in-valve 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; failed bioprosthetic valve; mitral valve replacement; clinical outcomes

DOI：

10.7507/1007-4848.202410045

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Objective To analyze the clinical efficacy of valve-in-valve transcatheter mitral valve replacement in the treatment of degenerated bioprosthetic mitral valves. Methods 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 were retrospectively analyzed, including baseline characteristics, surgical data, perioperative complications, and hemodynamic changes during the early postoperative and follow-up periods. Results A total of 31 patients were enrolled, including 7 males and 24 females with an average age of (66.57±9.32) years, and the average replacement time of surgical biological valves was (9.92±3.71) years. There were 7 cases transfemoral vene-atrial septal approach and 24 cases transapical approach. All patients showed significant improvement in cardiac function after operation, and the patients with New York Heart Association (NYHA) grade Ⅲ or Ⅳ and moderate and severe tricuspid valve regurgitation decreased. The peak flow velocity of mitral valve and the average transvalvular pressure gradient were decreased by echocardiography, and left ventricular ejection fraction had no significant change. One patient died of recurrent stroke on the 5th day after surgery, while the rest of the patients were discharged without complications such as cardiac death, all-cause death or outflow tract obstruction. During the median follow-up time of 12 months, no adverse events occurred and hemodynamics were stable. Conclusion The valve-in-valve transcatheter mitral valve replacement is safe and feasible for the treatment of patients with degenerated bioprosthetic mitral valves, demonstrating good hemodynamics and satisfactory short-term clinical outcomes.

1.	张海波, 潘湘斌, 郭应强, 等. 中国心脏二尖瓣生物瓣毁损介入瓣中瓣技术多中心专家建议. 中国胸心血管外科临床杂志, 2024, 31(8): 1090-1095.Zhang HB, Pan XB, Guo YQ, et al. Chinese mitral valve biological valve intervention valve technology multi-center expert advice. 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. 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. Ann Thorac Surg, 2009, 87(3): e18-e20.
4.	Mack M, Carroll JD, Thourani V. Transcatheter mitral valve therapy in the United States: A report from the STS-ACC TVT registry. 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. Circ Cardiovasc Interv, 2024, 17(8): e013782.
6.	张海波, 孟旭, 王胜洵, 等. 经导管二尖瓣生物瓣毁损的瓣中瓣治疗技术. 中华胸心血管外科杂志, 2019, 35(6): 331-333.Zhang HB, Meng X, Wang SX, et al. Midvalvular technique for the treatment of mitral valve biological valve mutilation. Chin J Clin Thorac Cardiovasc Surg, 2019, 35(6): 331-333.
7.	刘光辉, 冯德广, 王佳祥, 等. 二尖瓣生物瓣毁损行介入瓣中瓣的早期效果分析. 临床心血管病杂志, 2023, 39(1): 39-44.Liu GH, Feng DG, Wang JX, et al. Analysis of the early effect of interventional mitral valve in patients with biological mitral valve destruction. J Clin Cardiol, 2023, 39(1): 39-44.
8.	车波, 宋丹, 徐承义. 经导管瓣中瓣技术在二尖瓣生物瓣衰败中应用的临床现状. 中国心血管病研究, 2022, 20(5): 476-480.Che B, Song D, Xu CY. Clinical status of the application of transcatheter midvalve technique in mitral valve decay. 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 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 Am Heart Assoc, 2018, 7(14): e007767.
11.	Yoon SH, Whisenant BK, Bleiziffer S, et al. Transcatheter mitral valve replacement for degenerated bioprosthetic valves and failed annuloplasty rings. 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. Catheter Cardiovasc Interv, 2018, 92(4): E288-E298.
13.	Khan JM, Babaliaros VC, Greenbaum AB, et al. Anterior leaflet laceration to prevent ventricular outflow tract obstruction during transcatheter mitral valve replacement. 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. JAMA Cardiol. 2020; 5(11): 1245-1252.
15.	Jimenez-Diaz VA, Kapadia SR, Linke A, et al. Cerebral embolic protection during transcatheter heart interventions. EuroIntervention, 2023, 19(11): 549-570.
16.	Kapadia SR, Makkar R, Leon M, et al. Cerebral embolic protection during transcatheter aortic - Valve replacement. N Engl J Med, 2022, 387(14): 1253-1263.
17.	张靖男, 万俊义, 宋会军, 等. 经导管“瓣中瓣”置换术治疗二尖瓣置换术后生物瓣衰败的疗效评价. 中国循环杂志, 2023, 38(2): 165-170.Zhang JN, Wan JY, Song HJ, et al. Evaluation of the efficacy of transcatheter "in-valve" replacement in the treatment of biological valve decay after mitral valve replacement. 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. 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. Expert Review of Medical Devices, 2021, 18(7): 597-608.
20.	杨杰, 王斌, 陈翔, 等. 经导管行二尖瓣生物瓣毁损并重度主动脉瓣狭窄双瓣置换1例. 中国介入心脏病学杂志, 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. Chin J Interv Cardiol, 2022, 30(3): 235-237.
21.	周达新, 吴永健. 结构性心脏病介入治疗2023年度报告精要. 中国介入心脏病学杂志, 2024, 32(3): 121-135.Zhou DX, Wu YJ. Annual report on interventional therapy for structural heart disease in 2023. Chin J Interv Cardiol, 2024, 32(3): 121-135.

1. 张海波, 潘湘斌, 郭应强, 等. 中国心脏二尖瓣生物瓣毁损介入瓣中瓣技术多中心专家建议. 中国胸心血管外科临床杂志, 2024, 31(8): 1090-1095.Zhang HB, Pan XB, Guo YQ, et al. Chinese mitral valve biological valve intervention valve technology multi-center expert advice. 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. 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. Ann Thorac Surg, 2009, 87(3): e18-e20.
4. Mack M, Carroll JD, Thourani V. Transcatheter mitral valve therapy in the United States: A report from the STS-ACC TVT registry. 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. Circ Cardiovasc Interv, 2024, 17(8): e013782.
6. 张海波, 孟旭, 王胜洵, 等. 经导管二尖瓣生物瓣毁损的瓣中瓣治疗技术. 中华胸心血管外科杂志, 2019, 35(6): 331-333.Zhang HB, Meng X, Wang SX, et al. Midvalvular technique for the treatment of mitral valve biological valve mutilation. Chin J Clin Thorac Cardiovasc Surg, 2019, 35(6): 331-333.
7. 刘光辉, 冯德广, 王佳祥, 等. 二尖瓣生物瓣毁损行介入瓣中瓣的早期效果分析. 临床心血管病杂志, 2023, 39(1): 39-44.Liu GH, Feng DG, Wang JX, et al. Analysis of the early effect of interventional mitral valve in patients with biological mitral valve destruction. J Clin Cardiol, 2023, 39(1): 39-44.
8. 车波, 宋丹, 徐承义. 经导管瓣中瓣技术在二尖瓣生物瓣衰败中应用的临床现状. 中国心血管病研究, 2022, 20(5): 476-480.Che B, Song D, Xu CY. Clinical status of the application of transcatheter midvalve technique in mitral valve decay. 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 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 Am Heart Assoc, 2018, 7(14): e007767.
11. Yoon SH, Whisenant BK, Bleiziffer S, et al. Transcatheter mitral valve replacement for degenerated bioprosthetic valves and failed annuloplasty rings. 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. Catheter Cardiovasc Interv, 2018, 92(4): E288-E298.
13. Khan JM, Babaliaros VC, Greenbaum AB, et al. Anterior leaflet laceration to prevent ventricular outflow tract obstruction during transcatheter mitral valve replacement. 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. JAMA Cardiol. 2020; 5(11): 1245-1252.
15. Jimenez-Diaz VA, Kapadia SR, Linke A, et al. Cerebral embolic protection during transcatheter heart interventions. EuroIntervention, 2023, 19(11): 549-570.
16. Kapadia SR, Makkar R, Leon M, et al. Cerebral embolic protection during transcatheter aortic - Valve replacement. N Engl J Med, 2022, 387(14): 1253-1263.
17. 张靖男, 万俊义, 宋会军, 等. 经导管“瓣中瓣”置换术治疗二尖瓣置换术后生物瓣衰败的疗效评价. 中国循环杂志, 2023, 38(2): 165-170.Zhang JN, Wan JY, Song HJ, et al. Evaluation of the efficacy of transcatheter "in-valve" replacement in the treatment of biological valve decay after mitral valve replacement. 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. 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. Expert Review of Medical Devices, 2021, 18(7): 597-608.
20. 杨杰, 王斌, 陈翔, 等. 经导管行二尖瓣生物瓣毁损并重度主动脉瓣狭窄双瓣置换1例. 中国介入心脏病学杂志, 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. Chin J Interv Cardiol, 2022, 30(3): 235-237.
21. 周达新, 吴永健. 结构性心脏病介入治疗2023年度报告精要. 中国介入心脏病学杂志, 2024, 32(3): 121-135.Zhou DX, Wu YJ. Annual report on interventional therapy for structural heart disease in 2023. Chin J Interv Cardiol, 2024, 32(3): 121-135.

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