Concomitant transapical transcatheter aortic valve replacement and transapical balloon mitral valvuloplasty to treat severe aortic stenosis with severe mitral stenosis

Abstract

This paper reports concomitant transapical transcatheter aortic valve replacement (TA-TAVR) and transapical balloon mitral valvuloplasty (TA-BMV) for the first time. A 72-year-old man with a diagnosis of rheumatic severe aortic stenosis with mild insufficiency and rheumatic severe mitral stenosis with mild insufficiency was referred to the Department of Cardiac Surgery of Guangdong Provincial People’s Hospital. After the interdisciplinary discussion in the heart team (cardiac surgeon, cardiologist, anesthesiologist and image specialist), we decided to perform concomitant TAVR and BMV through one transapical approach considering the patient’s preference, NYHA class IV heart failure, and the calculated perioperative risk (Euroscore II 3.74%, STS score for the combined mitral and aortic procedure is not available). No intraoperative or postoperative complications were observed. stenosis, percutaneous mitral commissurotomy has been recommended, according to 2017 ESC/EACTS guideline for the management of valvular heart disease [Baumgartner 2017]. Patients with multivalvular stenosis comprise a special patient population, which is characterized by high perioperative morbidity and mortality, and simultaneous TA-TAVR and transapical transcatheter mitral valve replacement (instead of transapical balloon valvuloplasty due to the high Wilkins score) has been reported to treat severe aortic stenosis with severe mitral stenosis [Elkharbotly 2016]. To our knowledge, this paper reports concomitant transapical transcatheter aortic valve replacement (TA-TAVR) and transapical balloon mitral valvuloplasty (TA-BMV) for the first time.