{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T23:04:37Z","timestamp":1780009477469,"version":"3.53.1"},"reference-count":25,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In patients at elevated risk for redo mitral valve surgery, transcatheter mitral valve replacement (TMVR) can be taken into consideration as a less invasive alternative. However, long-term outcome data on mitral valve-in-ring (ViR) and valve-in-valve (ViV) procedures are scarce. We herein report the 3-year outcomes following these interventions.<\/jats:p>\n                  <jats:p>Between 2014 and 2023, 51 consecutive patients received ViR\/ViV TMVR at our center. Baseline, periprocedural, and 3-year outcome parameters were analyzed according to M-VARC criteria.<\/jats:p>\n                  <jats:p>Among 51 patients (70.9\u2009\u00b1\u200913.6 years, Society of Thoracic Surgeons (STS) score 3.3\u2009\u00b1\u20092.3%, left ventricular ejection fraction (LVEF) 50\u2009\u00b1\u200912%), 19 underwent ViR and 32 underwent ViV TMVR. Follow-up ranged from 1 to 71 months. The 30-day mortality rate was 5.9% (3\/51 patients). Over time, access shifted from transapical to transseptal (p for trend &lt;0.01). Rehospitalization, neurological events, and myocardial infarction occurred in 2.0% (1\/51 patients), 2.0% (1\/51 patients), and 0.0% of the cases, respectively. No structural valve failure was observed. Functional failure was 3.9% of cases due to significant residual mitral valve regurgitation (MR). Most paravalvular leak occluder implantations were performed in ViR patients (6\/9, 66.7%; four rigid rings and two semirigid rings). Three-year survival was 87.5% for ViR and 83.4% for ViV, with no difference between groups.<\/jats:p>\n                  <jats:p>Mitral ViR and ViV procedures demonstrate acceptable safety and clinical efficacy up to 3 years. Rigid annuloplasty rings are associated with an increased risk of significant residual regurgitation. Over the last decade, a clear transition from the transapical to the transseptal access has been observed, further reducing procedural trauma in this high-risk subset of patients.<\/jats:p>","DOI":"10.1055\/a-2679-5606","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T22:55:56Z","timestamp":1754952956000},"page":"332-340","source":"Crossref","is-referenced-by-count":0,"title":["Three-Year Outcomes Following Mitral Valve-in-Ring and Valve-in-Valve Procedures"],"prefix":"10.1055","volume":"74","author":[{"given":"Daniel Maldonado","family":"Gaekel","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf University Heart and Vascular Center, Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Waldschmidt","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart and Vascular Center, Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Ludwig","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart and Vascular Center, Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kalbacher","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart and Vascular Center, Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Schirmer","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf University Heart and Vascular Center, Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Blankenberg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart and Vascular Center, Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermann","family":"Reichenspurner","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf University Heart and Vascular Center, Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"Schofer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Medical Center Hamburg-Eppendorf University Heart and Vascular Center, Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf University Heart and Vascular Center, Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1055\/s-0044-1787853","article-title":"German Heart Surgery Report 2023: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery","volume":"72","author":"A Beckmann","year":"2024","journal-title":"Thorac Cardiovasc Surg"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s15027-015-0542-y","article-title":"Deutscher Herzbericht 2024","volume":"15","author":"Urban & 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Maisano","year":"2019","journal-title":"Eur Heart J"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"96","DOI":"10.21037\/acs-2019-mv-169","article-title":"Mitral valve-in-valve and valve-in-ring: tips, tricks, and outcomes","volume":"10","author":"L Pirelli","year":"2021","journal-title":"Ann Cardiothorac Surg"},{"issue":"01","key":"ref26","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1186\/s13019-021-01677-7","article-title":"Transcatheter mitral valve replacement for degenerated mitral valve bioprostheses, failure of mitral valvuloplasty and native valve with severe mitral annulus calcification: a systematic review and meta-analysis","volume":"16","author":"T You","year":"2021","journal-title":"J Cardiothorac Surg"},{"issue":"03","key":"ref27","doi-asserted-by":"crossref","first-page":"37","DOI":"10.14797\/mdcvj.1221","article-title":"Transcatheter mitral valve replacement in failed bioprosthetic valve, ring, and mitral annular calcification associated mitral valve disease using balloon expandable transcatheter heart valve","volume":"19","author":"H A Ueyama","year":"2023","journal-title":"Methodist DeBakey Cardiovasc J"},{"issue":"S 30","key":"ref28","doi-asserted-by":"crossref","first-page":"S3595","DOI":"10.21037\/jtd.2018.09.48","article-title":"Percutaneous or surgical access for transfemoral transcatheter aortic valve implantation","volume":"10","author":"A N Vora","year":"2018","journal-title":"J Thorac Dis"}],"container-title":["The Thoracic and Cardiovascular 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