Complete interventional heart repair of multiple concomitant cardiac pathologies in a staged approach

Area of Science:

• Interventional Cardiology
• Cardiac Surgery
• Geriatric Cardiology

Background:

• Limited evidence exists for multiple percutaneous cardiac procedures in patients with complex, co-existing cardiac pathologies.
• High-risk patients often face surgical rejection due to age and frailty, necessitating alternative treatment strategies.

Observation:

• A 90-year-old male with advanced heart failure, severe aortic stenosis, mitral regurgitation, coronary artery disease, and atrial fibrillation was deemed inoperable.
• The patient underwent a staged interventional approach: percutaneous coronary intervention, transfemoral aortic valve implantation, percutaneous mitral valve repair, and left atrial appendage closure.
• The final procedure was complicated by pericardial tamponade, requiring drainage.

Findings:

• The staged interventional approach was successfully completed in a complex, high-risk patient.
• Post-procedure, the patient experienced significant improvement in quality of life, with absence of dyspnea during daily activities.

Implications:

• This case highlights the feasibility of a staged, multi-procedure interventional strategy for select elderly patients with multiple cardiac conditions.
• Such approaches may offer a viable alternative to surgery, improving outcomes and quality of life in high-risk populations.
• Further research is warranted to establish the long-term efficacy and safety of this approach.