Percutaneous mitral valve-in-valve and valve-in-ring

Mitral valve disease is the most prevalent cardiac valvular disorder, with many patients requiring repeat procedures for failing prosthetic valves or severe dysfunction after the surgical annuloplasty ring. Traditional surgical approaches are associated with increased morbidity and mortality in this aging and increasingly frail population. Recent advances in percutaneous techniques have allowed for minimally invasive valve-in-valve and valve-in-ring procedures to avoid major cardiac surgery with repeat sternotomy. In this chapter we discuss the advances and current role of these percutaneous procedures and review the current literature regarding clinical outcomes. This chapter also highlights the importance of multimodality imaging in procedural planning, describes techniques for transcatheter valve implantation, and discusses the technical aspects of these procedures. There are many similarities between the valve-in-valve and valve-in-ring procedures; however, some important differences exist, and these will be reviewed.