ObjectiveTo summarize the results and clinical experience of transcatheter valve-in-valve implantation using domestic self-expanding valve in patients with aortic degenerated bio-prosthesis. MethodsFrom January 2019 to April 2023, the patients who underwent transcatheter valve-in-valve surgery in the Department of Cardiac Surgery of Tianjin Chest Hospital due to surgical bio-prosthesis failure were included. Characteristics of valves, perioperative complications, and hemodynamic manifestations during the early postoperative and follow-up period were analyzed. ResultsA total of 24 patients were enrolled, including 14 males and 10 females with an average age of 68.17±7.72 years, and the average interval between the two operations was 10.48±4.09 years. All patients were successfully discharged without complications such as coronary artery obstruction and pacemaker implantation, and the average transvalvular pressure gradient was 16.39±6.52 mm Hg before discharge. During the median follow-up time of 16 months, the left ventricular diastolic inner diameter and ejection fraction were continuously improved. ConclusionTranscatheter valve-in-valve using domestic self-expanding valves is safe and feasible to treat aortic bioprosthetic valve failure. Sound patient selection and surgical strategies are critical to achieve good hemodynamics.
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.