The first experience of two-stage transcatheter implantation of bioprostheses in mitral and tricuspid valve (Valve-in-Valve) prostheses in a high-risk surgical patient

Introduction. Structural degeneration of biological prosthetic heart valves is an inevitable complication in the long term, requiring repeated surgery. Repeated open surgery is associated with a high risk in comorbid patients. Valve-in-Valve (ViV) transcatheter technology has become a minimally invasive alternative.

Objective. To demonstrate the effectiveness and safety of a two-stage ViV strategy on tricuspid and mitral valves.

Material and methods. A clinical case of a patient born in 1947 with mitral valve (MC) and tricuspid valve (TC) bioprostheses 7 years after the initial open prosthetics is presented. The calculated risk of EuroSCORE II was 21.8%. A two-stage strategy was applied: on 09.29.2025, transcatheter implantation of the MyVal 30.5 mm bioprosthesis was performed in the tricuspid valve position, and on 10.10.2025, MyVal 27.5 mm was performed in the mitral valve position.

Results. The postoperative period was uneventful. Control echocardiography showed a significant improvement in hemodynamic parameters: the average gradient on TC decreased from 6.0-7.2 to 3.1 mmHg, regurgitation decreased from 2 to 0-1 art. On MC, the average gradient decreased from 9.0-10.5 mmHg to 6.7 mmHg, regurgitation was minimal. The patient's condition was satisfactory upon discharge, FC regressed from III-IV to II.

Conclusion. Two-stage transcatheter valve implantation using valve-to-valve technology is a highly effective and safe method of treating bioprosthesis dysfunction in high-risk surgical patients, which avoids repeated sternotomy and reduces rehabilitation time.

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