Transcatheter Mitral Valve-In-Valve – February 2025

Case and Plan:
64-year-old male presents with worsening dyspnea on minimal exertion, NYHA class III over the last few months. Past medical history is significant for RHD with severe MR and MS s/p bio-prosthetic MVR (31 mm Carpentier Edwards Pericardial valve)/ MAZE procedure in 2008, hemolytic anemia, atrial fibrillation-S/P ablation (2008 and 2013; on Apixaban), severe pulmonary hypertension and asthma. A recent TTE showed degeneration of the bio prosthesis with severe mitral stenosis with mean gradient was 10mmHg, moderate-severe pulmonary hypertension and LVEF 65%. Patient was evaluated by the Heart Team and was deemed high risk (even though STS mortality 1.3%) for re-op surgical mitral valve replacement due to recent unsuccessful attempt at open mitral valve repair due to hypotension during anesthesia induction. The patient is now planned for a mitral ViV TMVR with a 29mm SAPIEN-3 Ultra Resilia valve via transfemoral approach.