Transcatheter Mitral Valve-in-Valve Procedure for Dilated Cardiomyopathy Concomitant with Prosthetic Mitral Valve Dysfunction in a Heart Transplant Candidate

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Objective: The surgical treatment of severe mitral regurgitation concomitant with dilated cardiomyopathy (DCM) is challenging because of poor heart function. Herein, we have reported a successful transcatheter mitral valve-in-valve (TM-ViV) implantation (valve-in-valve procedure) in a heart transplant candidate.

Case Presentation: A 66-year-old man who suffered from DCM underwent mitral valve replacement for mitral regurgitation 7 years ago and was registered as a candidate for heart transplantation (status 2) at 65 years of age. He suffered from dyspnea on effort (New York heart association functional classification (NYHA) III) and his echocardiography revealed prosthetic mitral valve dysfunction (severe regurgitation). Because the surgical risk for prosthetic valve dysfunction was high (society of thoracic surgeons (STS) score: 11.2%), he was enrolled for on-pump TM-ViV procedure. The intraoperative and postoperative courses were uneventful, and echocardiography at the 18-month follow-up revealed low mean pressure gradient (4.2 mmHg) transmitral bioprosthesis and no paravalvular leakage.

Conclusions: On-pump transcatheter mitral valve implantation may be an important treatment option for severely injured left ventricular (LV) function with a failed bioprosthesis.