Medical College of Wisconsin
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Transseptal transcatheter mitral valve-in-valve: A step by step guide from preprocedural planning to postprocedural care. Catheter Cardiovasc Interv 2018 Sep 01;92(3):E185-E196



Pubmed ID




Scopus ID

2-s2.0-85019753584 (requires institutional sign-in at Scopus site)   53 Citations


Transcatheter mitral valve replacement has been successfully performed with the use of aortic transcatheter heart valves in hundreds of patients worldwide with severe dysfunction of a degenerated mitral bioprosthesis and high surgical risk for repeat operation. The delivery approach in the vast majority of the mitral valve-in-valve procedures has been transapical. Although the transseptal approach may be more technically challenging, it is less invasive and may be preferred by patients. Data from case series and a large international registry suggest that patients treated with transseptal mitral valve-in-valve have faster recovery, more improvement in left ventricular ejection fraction and possibly lower mortality compared with patients treated with transapical approach. A prospective clinical trial, the MITRAL trial (Mitral Implantation of TRAnscatheter vaLves) is evaluating the safety and feasibility of transvenous transseptal mitral valve-in-valve. The experience from this trial has allowed us to improve our procedural approach. In anticipation of a wider adoption of the transseptal approach for mitral valve-in-valve, we describe our current method step-by-step from planning the procedure through postprocedural management. This is an evolving technique that has changed with experience and the transition to newer generation transcatheter heart valve devices. We discuss the use of cardiac computed tomography for planning the procedure including transseptal puncture and valve size selection, provide procedural and technical tips, and discuss postprocedural care.

Author List

Guerrero M, Salinger M, Pursnani A, Pearson P, Lampert M, Levisay J, Russell H, Feldman T


Paul Joseph Pearson MD, PhD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cardiac Catheterization
Clinical Decision-Making
Echocardiography, Doppler, Color
Echocardiography, Three-Dimensional
Echocardiography, Transesophageal
Heart Valve Diseases
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Mitral Valve
Patient Selection
Perioperative Care
Predictive Value of Tests
Prosthesis Design
Prosthesis Failure
Recovery of Function
Risk Assessment
Time Factors
Tomography, X-Ray Computed
Treatment Outcome