Transcatheter aortic valve implantation with pre-existing mitral valve prosthesis using cardiopulmonary bypass: A...

Transcatheter aortic valve implantation (TAVI) is rarely performed in patients with a pre-existing mitral valve prosthesis, which was excluded from the Placement of Aortic Transcatheter Valve trial. Cardiopulmonary bypass (CPB) can provide sufficient hemodynamic stability to facilitate safe implantation; specifically, we prefer using normothermic femoro-femoral CPB. Careful attention should be paid to determine the positional relationship between the two valves in such patients.

We present a case of transfemoral TAVI using femoro-femoral CPB in a 90-year-old female patient with a pre-existing bioprosthetic mitral valve. Baseline echocardiography revealed severe aortic valve stenosis; hence, emergency balloon valvuloplasty was performed. Three months later, elective TAVI was performed; subsequently, left ventricular ejection fraction reached 63 % without mitral valve regurgitation or stenosis.

Despite the safety of TAVI using CPB in older patients, cannula insertion into peripheral vessels carries a high risk.

As CPB can increase tissue invasion for a short duration, the safety of this procedure needs further validation.