Transapical Transcatheter Valve-in-Valve Implantation for Failed Mitral Bioprostheses: Gradient, Symptoms, and Functional Status in 18 High-Risk Patients.

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Transapical Transcatheter Valve-in-Valve Implantation for Failed Mitral Bioprostheses: Gradient, Symptoms, and Functional Status in 18 High-Risk Patients Up to 5 Years Alfredo Giuseppe Cerillo, MD, Tommaso Gasbarri, MD, Simona Celi, PhD, Michele Murzi, MD, Giuseppe Trianni, MD, Marcello Ravani, MD, Marco Solinas, MD, Sergio Berti, MD The Annals of Thoracic Surgery Volume 102, Issue 4, Pages 1289-1295 (October 2016) DOI: 10.1016/j.athoracsur.2016.03.051 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Evolution of the intervalvular regurgitation during the study period. At discharge, 7 patients showed some degree of regurgitation. In particular, it was graded 2+/4+ in 2 patients and 1+/4+ in 5 patients. At follow-up, it had disappeared in all but 1 patient. Lines represent individual patients. The Annals of Thoracic Surgery 2016 102, 1289-1295DOI: (10.1016/j.athoracsur.2016.03.051) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Mean transprosthetic gradient during the study period (values are mm Hg). After a sudden decrease in mean transprosthetic gradient, it slightly increased through the follow-up period, as shown. Lines represent individual patients. The Annals of Thoracic Surgery 2016 102, 1289-1295DOI: (10.1016/j.athoracsur.2016.03.051) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Some degree of misalignment between the two prostheses was present: an asymmetric configuration is seen between a Carpentier-Edwards 27-mm pericardial valve and a 26-mm Sapien XT transcatheter heart valve in a computed tomography three-dimensional volume-rendered view. The Annals of Thoracic Surgery 2016 102, 1289-1295DOI: (10.1016/j.athoracsur.2016.03.051) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 A typical truncated cone shape (26-mm Sapien XT valve in 29-mm Carpentier-Edwards porcine mitral valve) on (A) computed tomography scan, and (B) angiography. The Annals of Thoracic Surgery 2016 102, 1289-1295DOI: (10.1016/j.athoracsur.2016.03.051) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 A typical hourglass shape (26-mm Sapien XT valve in 29-mm Medtronic Mosaic valve) on (A) computed tomography scan and (B) angiography. The Annals of Thoracic Surgery 2016 102, 1289-1295DOI: (10.1016/j.athoracsur.2016.03.051) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions