• Jian Ye, Anson Cheung, Michael Yamashita, David Wood, Defen Peng, Min Gao, Christopher R Thompson, Brad Munt, Robert R Moss, Philipp Blanke, Jonathon Leipsic, Danny Dvir, and John G Webb.
• Division of Cardiac Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: jye@providencehealth.bc.ca.
• JACC Cardiovasc Interv. 2015 Nov 1; 8 (13): 1735-44.

ObjectivesWe report our 8-year experience in transcatheter aortic and mitral valve-in-valve (VinV) implantation.BackgroundFeasibility and good early outcomes associated with transcatheter aortic and mitral VinV implantation into failed surgical bioprostheses have been confirmed, but the mid-term and long-term outcomes of transcatheter aortic and mitral VinV is unknown.MethodsA total of 73 patients with aortic (n = 42) and mitral (n = 31) bioprosthetic valve dysfunction underwent transcatheter VinV implantation between April 2007 and December 2013. Edwards balloon-expandable transcatheter valves (Edwards Lifesciences Inc., Irvine, California) were used. Median follow-up was 2.52 years with a maximum of 8 years.ResultsSeventy-two patients (mean age 79.7 ± 9.4 years, 32 women) underwent successful VinV implantation (success rate 98.6%). At 30 days, all-cause mortality was 1.4%, disabling stroke 1.4%, life-threatening bleeding 4.1%, acute kidney injury requiring hemodialysis 2.7%, and coronary artery obstruction requiring intervention 1.4%. No patient had greater than mild paravalvular leak. Estimated survival rates were 88.9%, 79.5%, 69.8%, 61.9%, and 40.5% at 1, 2, 3, 4, and 5 years, respectively. The small surgical valve size (19 and 21 mm) was an independent risk factor for reduced survival in aortic VinV patients. At 2-year follow-up, 82.8% of aortic and 100% of mitral VinV patients were in New York Heart Association functional class I or II.ConclusionsTranscatheter VinV for failed surgical bioprostheses can be performed safely with a high success rate and minimal early mortality and morbidity. Transcatheter VinV provides encouraging mid-term clinical outcomes in this high-risk elderly cohort of patients. Transcatheter VinV is an acceptable alternative therapy for failed aortic or mitral bioprostheses in selected high-risk patients.Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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