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Alternative Approach to Valve Replacement Surgery Effective

Transcatheter valve-in-valve implantation may be an option for high-risk elderly patients

FRIDAY, June 18 (HealthDay News) -- Transcatheter valve-in-valve implantation may be an effective option for high-risk elderly patients with degenerated bioprostheses in the aortic and mitral position, according to a study published online April 30 in Catheterization & Cardiovascular Interventions.

Moritz Seiffert, M.D., of the University Heart Center Hamburg in Germany, and colleagues performed transcatheter valve-in-valve implantation successfully in five patients who presented with significant xenograft degeneration a mean of 15.4 years after aortic and mitral valve replacement. The mean age of the patients was 82, and predicted operative mortality was 55.8 percent.

The researchers found that the mean transvalvular gradients were reduced from 31.2 to 19.0 mm Hg in the aortic position and 9 to 3 mm Hg in the mitral position with no significant regurgitation. Within 30 days, two patients died, with one due to low cardiac output and the other because of acute hemorrhage. One of these patients presented at the start of the study with a European System for Cardiac Operative Risk Evaluation of 88.9 percent.

"Transcatheter valve-in-valve implantation into degenerated bioprostheses in aortic and mitral position is feasible in patients with prohibitive contraindications to surgical valve replacement," the authors conclude. "An adequate patient selection and an interdisciplinary approach are crucial to the success of this procedure."

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