Transcatheter valve-in-valve or valve-in-ring implantation with a novel balloon-expandable device in patients with bioprosthetic left side heart valves failure: 1-year follow-up from a multicenter experience

Moscarella E. Ielasi A. Mussayev A. Montorfano M. Mullassari A. Martin P. Testa L. Jose J. Ninios V. Toutouzas K. Giannini F. Kertesz A. Unic D. Nissen H. Ezhumalai B. Senguttuvan N.B. Amat-Santos I. Seth A. Bedogni F. Tespili M.
1 April 2023 Elsevier Ireland Ltd

International Journal of Cardiology
2023 #376 35 - 45 pp.

Background: Transcatheter aortic and mitral valve-in-valve (ViV) or valve-in-ring (ViR) implantation into failed bioprosthetic heart valves (BHVs) or rings represents an appealing, less invasive, treatment option for patients at high surgical risk. Nowadays, few data have been reported on the use of balloon-expandable Myval (Meril Life Science, Vapi, India) transcatheter heart valve (THV) for the treatment of degenerated BHVs or rings. We aimed at evaluating the early and mid-term clinical outcomes of patients with left side heart bioprosthesis deterioration treated with transcatheter ViV/ViR implantation using Myval THV. Methods: 97 consecutive patients with symptomatic, severe aortic(n=33) and mitral(n=64) BHVs/ring dysfunction underwent transcatheter aortic ViV and mitral ViV/ViR implantation with Myval THV. Results: Technical success was achieved in 95 (98%) of the patients. Two cases of acute structural trans-catheter mitral ViV/ViR dysfunction requiring a second THV implantation were reported. At 30-day, a significant reduction in prosthetic trans-valvular pressure gradients and increase in valve areas were seen following both aortic and mitral ViV/ViR implantation. Overall survival at 15 months (IQR 8-21) was 92%. Patients undergoing mitral ViV/ViR had a relatively worse survival compared with those undergoing aortic ViV implantation (89% vs. 97% respectively; HR:2.7,CI:0.33-22.7;p=0.34). At longest follow-up available a significant improvement in NYHA functional class I and II was observed in patients with aortic and mitral ViV/ViR implantation(93.8% and 92.1%). Conclusions: Despite high surgical risk, transcatheter ViV/ViR implantation for failed left side heart bioprosthesis can be performed safely using Myval THV with a high success rate and low early and mid-term mortality and morbidity.

Aortic valve replacement , Bioprosthetic valve failure , Mitral valve replacement , Myval transcatheter heart valve , Transcatheter valve-in-ring , Transcatheter valve-in-valve

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Division of Clinical Cardiology, A.O.R.N. “SantAnna e San Sebastiano”, Caserta, Italy
Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
Cardiology Division, IRCCS Ospedale Galeazzi-SantAmbrogio, Milan, Italy
Catheterization Laboratory, National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
Interventional Cardiology Unit, IRCCS San Raffaele Scientific Insitute, Milan, Italy
The Madras Medical Mission Hospital, Chennai, India
Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas, Spain
Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
Department of Cardiology, Christian Medical College & Hospital, Vellore, India
Department of Cardiology, Interbalkan European Medical Center, Thessaloniki, Greece
First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens, Greece
GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
Department of Cardiology and Cardiac Surgery, University of Debrecen, Debrecen, Hungary
Department of Cardiac and Transplant Surgery, University Hospital “Dubrava”, Zagreb, Croatia
Depertment of Cardiology, Odense University Hospital, Odense, Denmark
Department of Cardiology, Fortis Malar Hospital, Adyar, Chennai, India
Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
CIBERCV, Interventional Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Fortis Escorts Heart Institute, New Delhi, India

Division of Clinical Cardiology
Department of Translational Medical Sciences
Cardiology Division
Catheterization Laboratory
Interventional Cardiology Unit
The Madras Medical Mission Hospital
Hospital Universitario de Gran Canaria Dr Negrin
Department of Cardiology
Department of Cardiology
Department of Cardiology
First Department of Cardiology
GVM Care & Research Maria Cecilia Hospital
Department of Cardiology and Cardiac Surgery
Department of Cardiac and Transplant Surgery
Depertment of Cardiology
Department of Cardiology
Department of Cardiology
CIBERCV
Fortis Escorts Heart Institute

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