Transcatheter valve-in-valve mitral valve replacement with SAPIEN 3 valve for bioprosthetic mitral valve failure: one-year outcomes in 26 patients.

Abstract

Objectives: To evaluate the one-year outcomes of valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) using the SAPIEN 3 valve for treating mitral bioprosthetic valve failure.

Methods: A retrospective analysis was conducted on 26 patients with mitral bioprosthetic valve failure who underwent ViV-TMVR at West China Hospital, Sichuan University, between November 2022 and July 2024. The age of patients was 71.5 (64.5-74.5) years, and 69.2% were female. Bioprosthetic valve failure occurred at a mean of (9.7±3.7) years after initial surgical implantation, with the most common failure mode being mixed stenosis and regurgitation (53.8%). The SAPIEN 3 valve was implanted via either a transseptal or transapical approach. Follow-up assessments, including clinical evaluation and echocardiography, were performed preoperatively, immediately post-procedure, and at 1 month, 6 months, and 1 year. Outcomes included all-cause mortality, quality of life, and postoperative complications.

Results: The procedure was performed via the transseptal approach in 21 patients (80.8%) and the transapical approach in 5 patients (19.2%) after failed transseptal puncture. All procedures were technically successful. No paravalvular leakage was observed immediately post-procedure, and mitral valve hemodynamics improved significantly. At the 1-year follow-up, 2 patients had died. Two patients (8.3% of survivors) were in New York Heart Association (NYHA) functional class Ⅲ, and the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 score improved significantly to (88.4±14.6) points (both P<0.01). Echocardiography at 1 year showed significant reductions in peak mitral valve velocity [to (2.29±0.32) m/s] and mean transvalvular pressure gradient [to (9.5±3.5) mmHg, 1 mmHg=0.133 kPa] compared to baseline (both P<0.05). No moderate or severe mitral regurgitation or paravalvular leakage was observed. The proportion of patients with moderate-to-severe pulmonary hypertension decreased significantly from 65.4% preoperatively to 13.0% at 1 year (P<0.01).

Conclusions: ViV-TMVR with the SAPIEN 3 valve for mitral bioprosthetic valve failure is associated with high procedural success, significantly improved valve hemodynamics, alleviation of pulmonary hypertension, enhanced patient QoL, and a low rate of complications at 1 year.