There were sporadic case reports of using transcatheter valve-in-valve (ViV) implantation to treat concomitant paravalvular leak (PVL) in failed surgical bio prostheses. However, the feasibility of this approach has never been well studied.
This study sought to evaluate the feasibility and clinical outcomes of transcatheter ViV implantation for concomitant bioprosthetic valve failure (BVF) and PVL.

We retrospectively reviewed the 165 patients underwent transcatheter mitral (n=104) or aortic (n=61) ViV implantation at a single center from 2014 February to 2023 June.
The severity of PVL was quantified by the vena contracta (VC) width and the clinical outcomes were evaluated by3D-TEE and according to the Valve Academic Research Consortium-2 criteria.

26 of the 165 (15.7%) patientsundergoing ViV implantation were identified with both BVF and mitral (n=16) oraortic (n=10) PVL. The procedural success rate of ViV was 100%. However,significant residual PVL≧moderate degree, defined as the VC width of PVL≧3mm, were evident in 5 of the 26 (19.2%)patients.Among the 13 patients with VC width ofPVL<3mm, the PVL became trivial or disappeared after ViV implantation. Forthe 7 patients with VC width of PVL between 3-5mm, the severity of PVL remainedunchanged after ViV. Transcatheter occluder was needed in 4 patients withlarger VC width of PVL≧5mm. One patient presented persistent hemolysis and/or heart failureduring follow-up.

Our data suggest that ViV implantationto treat concomitant BVF and mild PVL is feasible with good echocardiographicand clinical outcomes. For patients with VC width of PVL≧3mm, the severity of PVL remainsunchanged after ViV. Moreover, transcatheter occluder repair may be needed inthose patients with larger VC width of PVL≧5mm.