Jian YE
Current Position
Clinical Professor and Cardiac Surgeon
St. Paul’s Hospital, University of British Columbia
TAVI Session

Topic: Current Status of Mitral Valve in Valve Implantation


Bioprosthesis is preferred due to no need of long-term anticoagulation with warfarin, however, the average durability varies from 10 to 15 years in the mitral position, which means that younger patients will more likely need subsequent intervention for failed bioprostheses. Redo-surgery has been the standard treatment for these patients, but it may be associated with increased mortality and postoperative complications in elderly patients or those with multiple comorbidities. The advent of transcatheter heart valve therapies has opened up a wide range of therapeutic options for the treatment of failed bioprostheses. The safety and feasibility of transcatheter mitral valve-in-valve (MViV) have been well established. Early outcomes of MViV are very good with low early postoperative mortality and morbidity, which frequently leads to the conclusion that MViV should be considered as an option for most patients with failed surgical bioprostheses in publications. However, mid- and long-term outcomes remain unavailable. Careful deliberation is required since many important questions remain. Firstly, reports have showed high mean pressure gradients following MViV, particularly into smaller surgical bioprostheses. The long-term association of increased mean gradients with valve durability and long-term mortality remains unknown. Secondly, valve thrombosis seems more common following MViV, and the optimal anticoagulation strategy for MViV is still unknown. Lastly, tricuspid regurgitation is very common in patients with failed mitral bioprostheses and is associated with poor survival, higher incidence of recurrent heart failure, and decreased functional capacity. Concomitant tricuspid valve repair appears necessary in patients with moderate to severe tricuspid regurgitation or significantly dilated tricuspid annulus. In conclusion, transcatheter MViV for failed bioprostheses is a promising technique and preferred therapeutic option for elderly or high-risk patients. However, many important questions remain, clinicians must carefully weigh the knowns and unknowns to arrive at the best option for intermediate and low risk patients with failed mitral bioprostheses.