TMVIV Minimally Invasive Valve Repair: Fu Wai Hospital Successfully Treats 83-Year-Old High-Risk Patient

On November 26, Professor Yuan Yiqiang, Director of the Central China Branch of the National Center for Cardiovascular Diseases and President of Fu Wai Hospital, along with Dr. Liu Yuhao, Director of Structural Heart Disease Ward 1, and their expert team, successfully performed a Transcatheter Mitral Valve-in-Valve (TMVIV) implantation via the transfemoral venous approach. This minimally invasive technique successfully repaired the patient's severely damaged artificial heart valve without the need for open-chest surgery or cardiopulmonary bypass, saving the life of an 83-year-old critically ill patient.

The patient, Ms. Pan (83), had undergone a surgical mitral valve replacement over 20 years ago. Recently, the surgically implanted valve began to fail, leading to severe mitral regurgitation and acute symptoms of heart failure, making it impossible for her to lie flat. A traditional repeat open-heart surgery posed an extremely high, almost prohibitive risk for an elderly patient with multiple comorbidities and impaired cardiac function.

Following a multidisciplinary consultation, Professor Yuan Yiqiang and Dr. Liu Yuhao’s team decisively chose the TMVIV procedure, a preferred option recommended by international guidelines. Heralded as "a fine art in interventional cardiology," this technique uses a femoral vein puncture to establish access. Under the precise guidance of Transesophageal Echocardiography (TEE), the new valve (Valve-in-Valve) is accurately delivered and deployed inside the failing artificial valve, effectively resolving the severe backflow of blood.

Technical Advantages and Execution:

• Minimally Invasive: No thoracotomy (open chest) or cardiopulmonary bypass required; minimal trauma with blood loss under 5 ml.
• Precision: Under continuous real-time TEE monitoring, the delivery catheter navigated the vascular maze like a "lifeline," precisely positioning the valve in the area of most severe regurgitation.
• High Safety: The patient's heart maintained autonomous beating throughout the procedure, significantly enhancing surgical tolerance for elderly patients.

Following the meticulous procedure, TEE monitoring confirmed exhilarating results: Mitral regurgitation was reduced from severe to near-normal, and transvalvular pressure gradients met all standards. Ms. Pan's symptoms of chest tightness and shortness of breath were completely relieved, and she was able to ambulate with assistance on the second postoperative day.

The success of this TMVIV procedure provides a new, definitive minimally invasive solution for critically ill, elderly patients with surgically placed valves that have subsequently failed. It highlights Fu Wai Hospital's elite technical prowess in structural heart disease intervention and its patient-friendly approach tailored for advanced age and high-risk conditions.