2Department of Cardiology, Gülhane Research and Training Hospital, Ankara, Türkiye
CONTENT
We present an 80-year-old female with severe aortic stenosis and significant mitral regurgitation, previously treated with coronary artery bypass grafting and mitral ring annuloplasty (Video 1). Due to high surgical risk (STS score: 12.5%), simultaneous transfemoral aortic valve implantation and transseptal mitral valve-in-ring replacement were planned.
Under general anesthesia and transesophageal echocardiography guidance, transseptal access was established via an inferoposterior puncture. A 23-mm Myval balloon-expandable valve was deployed in the aortic position first (Video 2). Subsequently, a 26-mm Myval valve was implanted into the degenerated mitral ring with a transseptal approach (Video 3). Fluoroscopy confirmed optimal valve positioning without paravalvular regurgitation or left ventricular outflow tract obstruction (Video 4). The procedure was completed in 113 minutes, with a fluoroscopy time of 49 minutes. The patient was extubated in the operating room and discharged on postoperative day 5 without complications.
Simultaneous transcatheter valve replacement for aortic and mitral valve disease is emerging as a feasible alternative for high-risk surgical patients, despite limited clinical guideline support.1,
Footnotes
References
- Bashir M, Sigurdsson G, Horwitz PA, Zahr F. Simultaneous transfemoral aortic and transseptal mitral valve replacement utilizing SAPIEN 3 valves in native aortic and mitral valves. EuroIntervention. 2017;12(13):1649-1652.
- Ando T, Takagi H, Briasoulis A. A systematic review of reported cases of combined transcatheter aortic and mitral valve interventions. Catheter Cardiovasc Interv. 2018;91(1):124-134.