Work

Transseptal Transcatheter Balloon Expandable Valve-in-Valve-in-Ring Implantation in Mitral Position

Year: 2025

Type: article

Abstract: BACKGROUND: The durability of transcatheter mitral valve replacement (TMVR) using the Edwards Sapien valve in a mitral ring remains uncertain. This report details a complex transseptal valve-in-valve-in-ring procedure and discusses long-term outcomes. CASE SUMMARY: A 73-year-old man, with a history of coronary bypass surgery and mitral valve reconstruction, underwent valve-in-ring implantation with an Edwards Sapien 3 26-mm prosthesis 7 years ago. Now he presented with progressive dyspnea (NYHA functional class III) due to severe prosthetic valve degeneration. A transseptal valve-in-valve intervention was performed using an Edwards Sapien 3 Ultra Resilia 26-mm valve inside the degenerated Sapien 3 26-mm valve within a 30-mm Physio ring. DISCUSSION: Procedural challenges of valve-in-valve-in-ring interventions and their impact on TMVR longevity are reviewed, highlighting imaging guidance, transseptal puncture, and valve durability as key factors for long-term outcomes. TAKE-HOME MESSAGES: Transseptal valve-in-valve-in-ring implantation provides an alternative strategy for structural mitral valve deterioration. Long-term durability of TMVR requires continued assessment through dedicated registries and follow-up studies.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.106114