# First successful transcatheter valve-in-valve implantation into a failed mechanical prosthetic mitral valve after fracturing the discs: a case report

## TL;DR

A patient with a failed mechanical mitral valve received a new valve through a minimally invasive procedure after fracturing the old valve.

## Contribution

This is the first successful transcatheter valve-in-valve implantation into a failed mechanical mitral valve.

## Key findings

- A transcatheter valve was successfully implanted into a failed mechanical mitral valve after fracturing the discs.
- The patient remained stable with no complications more than three years after the procedure.
- This approach offers a potential alternative to surgical replacement for failed mechanical valves.

## Abstract

Until now, dysfunctional mechanical valves had to be treated surgically. Motivated by in vitro fracture experiments and the first successful clinical implantation of a transcatheter valve (TAVR) into the remaining ring in aortic position, this approach was considered for the mitral position for the first time.

A 31-year-old female patient with a history of four open-heart surgeries and severe neurologic complications presented with cardiac decompensation due to a fixed tilt of her mechanical bileaflet mitral valve prosthesis, resulting in mitral stenosis with a mean gradient of above 10 mmHg. An interventional approach was discussed. Using an apical access, the tilts were cracked under cerebral protection, and a balloon-implantable TAVR was implanted uneventfully. More than 3 years later, the patient is clinically stable, the valvular function is not impaired and the embolized fragment does not cause any problems in the distal abdominal aorta.

To the best of our knowledge, this is the first case report that demonstrates the possibility to implant a biological TAVR in a failed bileaflet mechanical mitral valve after fracturing the carbon tilts.