Delayed migration of Sapien valve following a transcatheter mitral valve-in-valve implantation.

We report two cases of delayed migration of the Sapien XT device after a successful mitral valve-in-valve (VIV) implantation. The procedure was performed through a transapical approach. Echocardiography was used to choose the size of the Sapien XT device. Although the immediate results were satisfactory both the cases presented with severe regurgitation (1 week and 3 months). Investigations revealed atrial migration of the Sapien device in both the cases, which was confirmed at the time of reoperation. We discuss possible mechanisms, which could have resulted in the delayed migration and highlight the difference between VIV procedures in mitral position versus other positions.