First-in-man full percutaneous transfemoral valve-in-valve implantations using Edwards SAPIEN 3 prostheses to treat a patient with degenerated mitral and aortic bioprostheses

Abstract

We report the case of a 64-year old man presenting with pulmonary oedema due to the degeneration of mitral and aortic bioprostheses. Baseline transthoracic and 3D transoesophageal echocardiography showed severe stenotic degeneration of the mitral bioprosthesis (Carpentier-Edwards bioprosthesis n°31), severe intraprosthetic aortic regurgitation (Perimount bioprosthesis n°27), left ventricular dilatation, decreased left ventricular ejection fraction at 50% and pulmonary hypertension. Because of severe comorbidities, the patient was denied redo surgery by the Heart Team (logistic EuroSCORE 2: 23, 85%). Transcatheter transfemoral mitral valve-in-valve implantation was first performed using a 29-mm SAPIEN 3 valve. Two weeks later, aortic valve-in-valve implantation was performed with the same approach using a 26-mm SAPIEN 3 valve. Four months later, the patient remained asymptomatic with good haemodynamic results for both prostheses. This case report illustrates that valve-in-valve implantations using a full percutaneous transfemoral approach may be a valuable alternative to conventional surgery in high-risk patients presenting with concomitant mitral and aortic bioprosthesis dysfunction.

Keywords: Bioprosthesis; High-risk populations; Transcatheter valve implantation; Valve-in-valve.