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Nappi et al. Vessel Plus 2021;5:40 Vessel Plus
DOI: 10.20517/2574-1209.2021.06

Review Open Access

Transcatheter valve-in-valve implantation vs.

reoperative mitral valve surgery for failing surgical
prosthesis

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2
4
1
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Francesco Nappi , Emanuele Verghi , Sanjeet Singh Avtaar Singh , Antonio Nenna , Pierluigi Nappi ,
2
Camilla Chello , Massimo Chello 2
1
Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris 93200, France.
2
Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome 00128, Italy.
3
Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow G1 2FF, UK.
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Department of Clinical and Experimental Medicine, University of Messina, Messina 98121, Italy.
Correspondence to: Prof. Francesco Nappi, MD, Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, 36 Rue des
Moulins Gémeaux, Saint-Denis 93200, France. E-mail: francesconappi2@gmail.com
How to cite this article: Nappi F, Verghi E, Singh SSA, Nenna A, Nappi P, Chello C, Chello M. Transcatheter valve-in-valve
implantation vs. reoperative mitral valve surgery for failing surgical prosthesis. Vessel Plus 2021;5:40.
https://dx.doi.org/10.20517/2574-1209.2021.06
Received: 12 Jan 2021 First Revised: 9 Feb 2021 Revised: 13 Feb 2021 Accepted: 9 Mar 2021 Published: 19 Jul 2021
Academic Editor: Manel Sabate Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
The incidence of degenerated mitral bioprosthesis is increasing in clinical practice due to a greater use of biological
prostheses for mitral valve replacement compared to mechanical valves and increased life expectancy after cardiac
surgery. Similarly, mitral valve repair can result in long-term recurrence of mitral valve disease requiring
reintervention. Therefore, the number of failing surgical prosthesis or repaired valves will increase over the next
years representing a new challenge in the corrective approach in the case of long-term structural valve
degeneration. Those patients were generally managed with reoperative mitral valve surgery, but transcatheter
interventional therapies, initially considered an option in patients who are ineligible for redo surgery, have been
recently associated with excellent outcomes. The efficacy and safety of transcatheter mitral valve procedures have
been reported in both failing ring annuloplasty or degenerated mitral bioprosthesis, but the use of non-dedicated
devices remains associated with significant severe complications such as device malpositioning or left ventricular
outflow tract obstruction requiring emergent conversion to open surgery. Both the careful selection of patients and
pre/intra-procedural scheduling are warranted to maximize benefits and reduce issues. This review focuses on
emerging transcatheter mitral valve replacement devices as therapeutic options for degenerated mitral
bioprosthesis or failed mitral repair. This paper aims to summarize current interventional techniques and available
evidence, comparing outcomes between transcatheter technologies and reoperative mitral valve surgery.

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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