Introduction: Transcatheter mitral Valve-in-Valve (ViV) & Valve-in-ring (ViR) are relatively novel therapeutic alternatives for patients with degenerated bioprostheses or failed annuloplasty rings whose reoperative risk is too high. The predominant procedural access for both procedures is transapical or transseptal. However, whether there are differences in outcomes of this procedure using transseptal versus transapical access has not yet been defined. Methods: We conducted a systematic review of all published articles from MEDLINE and EMBASE to explore the outcomes of these two procedural approaches. Results: A total of 55 studies including 183 patients (154 ViV and 29 ViR) were included. Patients that underwent ViV (101 transapical and 53 transseptal) using the transseptal approach required more iatrogenic atrial septal defect (ASD) closure (19% versus 0. 0 %; P < 0. 001) and hence had a lower device success rate (68% versus 89%; P = 0. 001). However, there was no significant difference between the two groups in procedural success and all-cause mortality at 30 days. Overall severe bleeding complications (major or life threatening) were not different the two groups (3. 7% versus 7. 9%; P = 0. 321). In the ViR group (19 transapical and 10 transseptal), no difference in procedural success, device success or 30-day outcomes were identified between transseptal and transapical groups, although sample size was small. Conclusion: In conclusion, mitral ViV and ViR using the two different procedural approaches appear to confer equal and reasonable 30-day outcomes.

Background: The initial trial in tricuspid surgery is repair; however, replacement is done whenever the Valve is badly diseased. Tricuspid Valve replacement comprises 1.7% of all tricuspid Valve surgeries.Materials and Methods: The present retrospective study was performed using the medical records of 21 cases who underwent tricuspid Valve replacement from January 2002 until the end of December 2010. The mean age of the participants was 52.3±8.8 years and 66.7% were females. In addition, tricuspid Valve replacement was associated with mitral Valve surgery, aortic Valve surgery, and both in 14.3%, 4.8%, and 33.3% of the cases, respectively. Yet, isolated tricuspid Valve replacement and redo surgery were performed in 10 cases (47.6%) and 8 cases (38.1%), respectively. Besides, trial of repair was done in 14 cases (66.7%). Moreover, biological and mechanical Valves were used in 76.2% and 23.8% of the patients, respectively.Results: According to the results, early mortality was 23.8% and one year survival was 66.7%. Moreover, early mortality was caused by right ventricular failure, multiorgan failure, medistinitis, and intracerbral bleeding in 42%, 28.6%, 14.3%, and 14.3% of the cases, respectively. In addition, 57.1% of the deaths had occurred in the cases where the biological Valve was used, while 42.9% of the deaths had taken place where the mechanical one was utilized.Conclusions: The patients who require tricuspid Valve replacement are usually high risk surgical candidates with early and long term mortality. The findings of the current study showed no significant hemodynamic difference between mechanical and biological Valves.

Objective: Aortic Valve replacement for aortic regurgitation (AR) has been established as a standard treatment but implies prosthesis-related complications. Aortic Valve repair is an alternative approach, but its mid- to long-term results still need to be defined.Methods: Over a 12-year period, 640 patients underwent aortic Valve repair for regurgitation of a unicuspid (n=21), bicuspid (n=205), tricuspid (n=411) or quadricuspid (n=3) aortic Valve. The mechanism of regurgitation involved prolapse (n=469) or retraction (n=20) of the cusps, and dilatation of the root (n=323) or combined pathologies. Treatment consisted of cusp repair (n = 529), root repair (n=323) or a combination of both (n = 208). The patients were followed clinically and echocardiographically; follow-up was complete in 98.5% (cumulative follow-up: 3035 patient years). Results: Hospital mortality was 3.4% in the total patient cohort and 0.8% for isolated aortic Valve repair. The incidences of thrombo-embolism (0.2% per patient per year) and endocarditis (0.16%per patient per year) were low. Freedom from re-operation at 5 and 10 years was 88% and 81% in bicuspid and 97% and 93% in tricuspid aortic Valves (p=0.0013). At re-operation, 13 out of 36 Valves could be re-repaired. Freedom from Valve replacement was 95% and 90% in bicuspid and 97% and 94% in tricuspid aortic Valves (p=0.36). Freedom from all Valve-related complications at 10 years was 88%.Conclusions: Reconstructive surgery of the aortic Valve is feasible with low mortality in many individuals with aortic regurgitation. Freedom from Valve-related complications after Valve repair seems superior compared to available data on standard aortic Valve replacement.

Infective endocarditis is one of the most severe complications of parenteral drug abuse. The outstanding clinical feature of infective endocarditis in intravenous drug abusers is the high incidence of right-sided Valve infection, and the tricuspid Valve is involved in 60% to 70% of the cases. We herein report a case of isolated pulmonic Valve infective endocarditis with a native pulmonary Valve.

Background: Pulmonary Valve replacement is inevitable for the majority of patients with long-standing pulmonary regurgitation. The purpose of this study was to describe the experience of employing a novel technique to create an intraoperatively handmade trileaflet pulmonary Valve with glutaraldehyde-treated autologous pericardium (the AAA Valve).Methods: This case series study was conducted from September 2018 to March 2021 at Shiraz University of Medical Sciences, Shiraz, Iran. The surgical technique involved harvesting and treating with glutaraldehyde of the pericardium, constructing a trileaflet Valve by encapsulating the pericardium within a Dacron tube with a diameter of 22 mm and a length of 20 mm, and implanting it into the pulmonary Valve position.Results: The AAA Valve was constructed for 10 patients with a mean age of 16.20±5.81 years, seven of whom had undergone surgery for tetralogy of Fallot. The patients’ mean follow-up length was 32.30±13.64 months. The AAA Valve regurgitation was none to moderate. At the time of follow-up, all patients had AAA Valve stenosis that was less than moderate, except for one case. Cardiac magnetic resonance imaging and echocardiography results confirmed mild leaflet motion restriction in the patient with moderate stenosis. The anatomic Valve parameters in MRI revealed a mean geometric height, coaptation height, and effective height of 20.23±2.40 mm, 10.42±1.67 mm, and 14.34±2.24 mm, respectively. One patient died from non-cardiac causes.Conclusion: The surgical establishment of a native pericardial Valve in the pulmonary Valve position yielded satisfactory short-term to midterm results and might be considered a viable alternative to the available options.