Transcatheter mitral valve-in-valve: treatment of rheumatic heart disease in young patients

Abbey Knox, Jayme S. Bennetts, Damian Gimpel, Richard F. Newland, Robert A. Baker, Majo X. Joseph, Gregory D. Rice, Nadarajah Kangaharan, Ajay Sinhal

Research output: Contribution to journalArticlepeer-review


Background: Rheumatic heart disease (RHD) in young people presents a complex management problem. In Australia a significant proportion of those affected are Aboriginal and Torres Strait Islanders. Transcatheter mitral valve-in-valve (TMViV) replacement has emerged as an alternative to redo surgery in high-risk patients with degenerated mitral bioprostheses. The aim of this study is to review outcomes of TMViV replacement in young patients with RHD. 

Methods: A single-centre, retrospective review of prospectively collected data on patients undergoing TMViV from December 2017 to June 2021. Primary outcome was major adverse cardiovascular events. Secondary outcome was post-operative trans-thoracic echocardiogram (TTE) results. 

Results: There were seven patients with a mean age of 33 years and predominantly female (n = 5). Pre-operative comorbidities included diabetes (29%), chronic obstructive pulmonary disease (43%), left ventricular dysfunction (43%) and current smoking status (80%). Post-operative median length of hospital stay was 4 days with no post-operative renal failure, stroke, return to theatre, valve embolization or in hospital mortality. Post-operative TTE showed either nil or trivial central mitral regurgitation, no paravalvular leak and a median gradient of 5 mmHg (IQR 4.5, 7) across the new bioprosthesis; sustained at median follow-up of 22 months. 

Conclusion: Current literature of TMViV replacement is focused on an older population with concurrent comorbidities. This study provides a unique insight into TMViV replacement in a young cohort of patients with complex social and geographical factors which sometimes prohibits the use of a mechanical valve. The prevalence of RHD remains high for Aboriginal and Torres Strait Islanders, planning for future repeat valve operations should be considered from the outset. We consider TMViV as a part of a staged procedural journey for young patients with RHD.

Original languageEnglish
Pages (from-to)3298-3303
Number of pages6
JournalANZ Journal of Surgery
Issue number12
Early online date6 Oct 2022
Publication statusPublished - Dec 2022


  • Aboriginal and Torres Strait Islander
  • degenerated bioprosthesis
  • rheumatic heart disease
  • transcatheter mitral valve-in-valve


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