Image-Based Decision-Making Treatment of Degenerated Mitroflow and Trifecta Prostheses

Purpose. In the present report we describe our clinical experience using specific image-based decision making and anatomic considerations for transcatheter valve-in-valve (ViV) implantation in degenerated xenografts with their pericardial leaflets externally mounted around the stent (Mitroflow [SORIN Group, Milan, Italy] or Trifecta [St. Jude Medical, St Paul, MN]). This design seems to increase the risk of coronary ostia obstruction after ViV procedures. Description. We report 5 patients with degenerated Mitroflow or Trifecta xenografts in whom different anatomic considerations led to different treatment strategies. Evaluation. One patient underwent conventional redo aortic valve replacement, 2 patients underwent transcatheter ViV implantation with first-generation prostheses, and 2 patients underwent transcatheter ViV implantation using the Engager prosthesis (Medtronic, Minneapolis, MN). All patients were discharged alive in good clinical condition and were alive at 30 days after the procedure. Conclusions. Transcatheter ViV procedures can be performed safely in degenerated Mitroflow and Trifecta prostheses, if the anatomy of the aortic root is taken into consideration. Precise preoperative image-based decision making is mandatory. The Engager prosthesis may allow for ViV procedures even in patients with smaller aortic roots. (C) 2014 by The Society of Thoracic Surgeons