Simultaneous transapical transcatheter aortic valve replacement and transcatheter mitral valve replacement for native valvular stenosis

Abstract

Transcatheter aortic valve replacement (TAVR) is well established for patients who cannot undergo surgery (Leon et al., N Engl J Med 2010;363:1597) or are high risk for surgery (Smith et al., N Engl J Med 2011;364:2187-2198). Experience with the TAVR procedure has led to recent reports of successful transcatheter mitral valve replacement (TMVR) procedures (Cheung et al., J Am Coll Cardiol 2014;64:1814; Seiffert et al., J Am Coll Cardiol Interv 2012;5:341-349) separately or simultaneously with the TAVR. However, these reports were of simultaneous valve-in-valve procedures (Cheung Anson, et al. J Am Coll Cardiol 2013;61:1759-1766). A recent report from Portugal also reported simultaneous transpical implantation of an inverted transcatheter aortic valve-in-ring in the mitral position and transcatheter aortic valve (Hasan et al., Circulation 2013;128:e74-e76). There has been an experience of TMVR only in native mitral valve for mitral valve stenosis, but none in both aortic and mitral valves. We report the first in human case of simultaneous transapical TAVR and TMVR in native valves secondary to valvular stenosis. Our patient was not a candidate for percutaneous balloon mitral valvuloplasty secondary to a high Wilkins Score. Sizing of the aortic valve was based on the transesophageal echocardiogram (TEE), whereas sizing of the mitral valve was based on TEE measurements and balloon inflation during left ventriculography. © 2015 Wiley Periodicals, Inc.

Successful First-in-Man Concomitant Transapical Transcatheter Aortic and Mitral Valve Replacements for Severe Native Aortic and Mitral Valve Stenosis Using the Edwards Certitude Delivery System

“…These patients often have concomitant mitral stenosis with a high Wilkins score, barring them from mitral balloon valvuloplasty. The option of performing TMVR of native mitral stenosis at the same time as TAVR, although not previously studied, has been reported in two cases [5,6]. To the best of our knowledge, this is the first simultaneous TAVR and TMVR of native aortic and mitral valves stenoses utilizing a single transapical access with the Edwards Certitude delivery system.…”

“…Results from a global registry show that TMVR, when performed in highly selected patients, results in significant adverse events [4]. Simultaneous TAVR and TMVR of stenotic native valves has only been reported in two cases [5,6]. Here, we report the first case of simultaneous TAVR and TMVR for severely stenotic native aortic and mitral valves in a high-risk patient using the Edwards Certitude transapical delivery system (Edwards Lifesciences, Irvine, CA, USA) ( Figure 1).…”

“…Bauernschmitt et al [5] chose to implant the mitral valve first due to the anatomical proximity and concern for compression of the smaller aortic valve while implanting the larger mitral prosthesis. In Elkharbotly's case [6], the aortic valve was placed first. In our case, the aortic valve was implanted first due to the critical nature of the aortic stenosis and in case of unexpected complications occurring during mitral valve intervention.…”

“…In the Bauernschmitt case [5], valve migration was not noted before the patient died from malignancy 9 months after implantation. In the Elkharbotly case [6], the reported 6-month follow-up was…”

Perioperative transoesophageal echocardiography: current status and future directions

“…Its role is established as the modality of choice for management of life-threatening emergencies 2 3. Other applications include its use as a qualitative and quantitative cardiac structural and functional monitor before and after interventions 4 5. Real-time three-dimensional (RT-3D) imaging has expanded its role as a procedural adjunct during minimally invasive and percutaneous cardiac interventions (figure 1).…”