Combined Transapical Valve-in-Valve/Valve-in-Ring Transcatheter Mitral Valve Implantation and Paravalvular Leak Closure for Failed Mitral Valve Surgery

Abstract Recurrent mitral regurgitation (MR) after mitral valve repair or replacement is associated with adverse outcomes. MR may be transvalvular, paravalvular/para-ring, or both, and careful evaluation with transesophageal echocardiography is required. Often patients have high risk of morbidity or mortality, and transcatheter therapies are emerging as an alternative to reoperation. We present two cases of complex recurrent mitral regurgitation treated by a transapical transcatheter approach and discuss important clinical and technical considerations.