Objectives: There is an ongoing discussion if valve-in-valve implantations into failing mitral xenografts should be performed only via a transapical approach.
Background: In selected high-risk patients, transcatheter valve implantation is an emerging therapy for degenerated mitral xenografts in need of repeated valve replacement.
Methods: Here we describe three different strategies to treat a failing mitral biological prosthesis (Carpentier Edwards S.A.V) by implantation of a SAPIEN-XT valve, which was performed in three different patients. As access site, a transjugular/transseptal approach, a transfemoral/transseptal approach, and a transapical approach were chosen.
Results: With all three approaches, valve-in-valve implantation was successfully achieved. The acute hemodynamic effects were excellent and according to VARC there was no adverse event recorded during a 6 months follow-up.
Conclusions: Feasibility of all three approaches is demonstrated and might be taken into consideration for treatment in various patients.
Keywords: bioprosthesis; mitral regurgitation; transcatheter valve implantation.
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