Bioprosthetic Valve Failure: Management Strategies in the Mitral Position.

BACKGROUND: Bioprosthetic valve failure is a growing clinical challenge, particularly in younger patients with comorbidities. Transcatheter valve-in-valve implantation is an alternative to redo surgery but may fail in cases of severe calcification or infection. CASE SUMMARY: A 37-year-old man with systemic lupus erythematosus and end-stage renal disease on hemodialysis presented with NYHA functional class III dyspnea. He had undergone mitral valve replacement (MVR) with a bioprosthetic valve 12 years before, followed by transcatheter mitral valve-in-valve (ViV) implantation 9 years later. Two years post-ViV, he developed recurrent severe mitral stenosis with a mean gradient of 24 mm Hg, extensive mitral annular calcification, and severe pulmonary hypertension. DISCUSSION: Bioprosthetic valve failure represents a significant challenge in clinical practice, especially in patients with multiple comorbidities or prior interventions. This case demonstrates the progression from surgical bioprosthetic MVR to transcatheter ViV implantation and ultimately redo surgery. TAKE-HOME MESSAGES: This case highlights that optimal management of bioprosthetic mitral valve failure requires individualized, multidisciplinary decision-making. Surgical re-intervention remains essential for patients with severe annular calcification or complications after transcatheter procedures.