Mitral valve (MV) repair with an annuloplasty device is the preferred surgical therapy for mitral regurgitation (MR). Recent studies have called into question the durability of MV repair for functional, degenerative, and congenital etiologies. The recurrence rate of significant MR after undersized annuloplasty for ischemic MR approaches 30% 6 months after surgery. Recent studies have documented the development of recurrent MR after repair for degenerative etiologies to be 2% to 4% per year. Because of very complex pathologies, recurrence of MR following valve repair for congenital anomalies is also common. Recently the development of novel valve technologies has made the percutaneous replacement of the aortic and pulmonary valves possible. However, percutaneous replacement of the MV is not currently possible because of inherent anatomic features of the MV that make fixation and perivalvular seal with currently available devices a challenge. Recent clinical reports and animals studies have demonstrated that the presence of a surgically placed annuloplasty device or a bioprosthetic valve makes MV replacement with valved stents feasible. This technique has been termed the valve-in-ring (VIR) or valve-in-valve (VIV) procedure and has been performed surgically via transatrial and transapical approaches using the Sapien transcatheter heart valve (Edwards Lifesciences, Irvine, California). Given the growing awareness of the limitations of valve repair durability, VIR offers a potential remedial procedure for high-risk adult and pediatric patients who develop recurrent MR after MV repair.
Percutaneous Mitral Valve in Edwards Physio I ® semi-flat ring (Amplatzer ASD closure device can be seen to left)
Percutaneous Mitral Valve in Edwards Physio I ® semi-flat ring
Percutaneous Mitral Valve in Medtronic Duran ® flexible ring