Transcatheter mitral valve implantation using the Tendyne valve in a patient with prior transcatheter aortic valve implantation: a case report

Abstract

Background The presence of aortic and mitral disease in a patient who is not a suitable candidate for surgical correction poses significant challenges in the diagnostic workup as well as management plans. The percutaneous treatment can be staged to fix the aortic valve with transcatheter aortic valve implantation (TAVI) as a first step, followed by reassessment and percutaneous correction of mitral regurgitation. Case Summary A 65-year-old female with multiple co-morbidities presented with acute coronary syndrome and heart failure. She was diagnosed with three-vessel coronary artery disease and degenerative low-flow low-gradient severe aortic stenosis, along with severe degenerative mitral regurgitation with a left ventricular ejection fraction of 35%. Due to high surgical risk, she underwent multi-vessel percutaneous coronary intervention (PCI) with stenting. Transcatheter aortic valve implantation was done as a staged procedure which partially improved her symptoms. Mitral regurgitation was not suitable for percutaneous mitral valve edge-to-edge repair (TEER). After the heart team discussion, she underwent transcatheter mitral valve implantation (TMVI) using the Tendyne mitral valve (Tendyne™, Abbott) through a transapical approach. There was no paravalvular leak, and the mean gradient across the valve was 2 mm/Hg. She was symptomatically better at follow-up and an echocardiogram showed normally functioning aortic valve and Tendyne mitral valves. Discussion Transapical transcatheter mitral valve implantation using the Tendyne valve is a feasible option in patients with prior TAVI. This can be considered an alternative treatment for mitral regurgitation in such patients who are not suitable for edge-to-edge mitral repair.