Page 33 - Journal of Structural Heart Disease Volume 1, Issue 3

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Original Scientific Article
Video 1. Angiogram showing the valve in valve concept in mi- tral position in a sheep. A bioprosthetic valve (Mosaic, Medtronic) has been surgically placed. A Melody valve has been thereafter placed inside the surgical valve used as a landing zone. (Boud- jemline et al, Eur Heart J. 2005;26:2013-7)
ic risk and the need for long-term anticoagulation therapy as required with mechanical prostheses. However all bioprosthetic valves eventually fail over time with progressive age induced degeneration. Re- peat sternotomy in such patients carries a high risk of morbidity and mortality. Transcatheter valve-in-valve implantation has emerged as a promising treatment option for degenerated bioprosthetic heart valves in these multi-operated high-risk patients and has been described for failing bioprosthetic valves in all four cardiac locations [9].
Evolution
In an early preclinical study, Boudjemline et al. [10] were the first to evaluate the proof of concept of mitral valve-in-valve treatment in a sheep model. A bovine jugular valve was mounted on a stent and success- fully implanted off-pump through a transatrial mini- invasive approach in 6 sheep (Video 1 and Video 2). In a subsequent animal study, Zegdi et al. [11] reported the successful implantation of a repositionable valved stent (porcine aortic valve sutured on a nitinol self ex- pandable stent) in tricuspid bioprosthetic valves. The originality of the delivery system consisted of the pos-
Video 2.
Echographic imaging showing the valve in valve con- cept in mitral position in a sheep. (Boudjemline et al, Eur Heart J. 2005;26:2013-7.)
sibility of controlling reversibly the deployment of the valvedstentasmanytimesasneededbeforethefinal release, to allow implantation in appropriate position (Figure 1 and Videos 3 to 7).
Since then successful percutaneous valve- in-valve implantations in humans have been especial- ly reported for pulmonary and aortic valves [12, 13]. The first human case of transcatheter valve-in-valve implantation in the tricuspid position was described by Van Garsse and colleagues [14]. Since then sever- al anecdotal case reports and small case series using two different valves: the Melody® valve (Medtronic, Minneapolis, Minnesota, USA) and the Edwards SA- PIENTM valve (Edwards Lifesciences, Irvine, California, USA) have been described [15-22]. These procedures were performed in a heterogeneous population, in- cluding children and adults with congenital heart disease, patients with prior infective endocarditis, and patients with a history of rheumatic or carcinoid heart disease.
The first multicentric series of percutaneous tricus- pid VIV replacement using Melody valve in 15 patients with good results was published in 2011 (age range 8 to 64 years) [16]. The primary indication for the pro- cedure was predominantly stenosis in 10 and regur-
Jalal, Z. et al.
Transcatheter Tricuspid Valve Therapies