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Simultaneous Transcatheter Aortic and Mitral Native Valve Replacement: A Step-by-Step Procedural Approach

Julio I Farjat-Pasos1, Dimitri Kalavrouziotis2, Jonathan Beaudoin3

  • 1Department of Structural Interventional Cardiology, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada.

Structural Heart : the Journal of the Heart Team
|August 5, 2024
PubMed

Insights

Simultaneous transcatheter valve replacement (STVR) offers a minimally invasive option for complex multivalvular heart disease (MVHD). This first-in-human case demonstrates the feasibility of fully percutaneous STVR for aortic regurgitation and mitral stenosis.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Multivalvular heart disease (MVHD) affects one-third of valvular heart disease patients, leading to significant hemodynamic impact, higher heart failure rates, and mortality, especially with multiple valve interventions.
  • Current guidelines for combined aortic regurgitation and mitral stenosis involve staged interventions, aiming to mitigate mortality risks associated with double-valve replacement.
  • Simultaneous transcatheter valve replacement (STVR) for native MVHD is largely off-label with limited evidence, yet it presents a promising minimally invasive approach.

Purpose of the Study:

  • To report the first case of a fully percutaneous transfemoral simultaneous transcatheter valve replacement (STVR) for native multivalvular heart disease (MVHD) involving aortic regurgitation and mitral stenosis.
  • To detail the procedural planning considerations, step-by-step execution, and critical aspects of performing simultaneous aortic and mitral STVR.
  • To present the procedural and follow-up outcomes of this novel approach for complex MVHD.

Main Methods:

  • A comprehensive procedural planning strategy was developed, considering the specific pathological interactions of aortic regurgitation and mitral stenosis.
  • A step-by-step guide for performing a fully percutaneous transfemoral simultaneous aortic and mitral STVR was meticulously followed.
  • Procedural steps and critical considerations were documented, alongside the evaluation of immediate procedural and subsequent follow-up results.

Main Results:

  • Successful completion of a fully percutaneous transfemoral simultaneous transcatheter valve replacement (STVR) for native multivalvular heart disease (MVHD) with aortic regurgitation and mitral stenosis.
  • The procedure involved detailed planning and execution, highlighting critical considerations for managing combined valve pathologies.
  • Favorable procedural and follow-up results were achieved, demonstrating the potential of this minimally invasive technique.

Conclusions:

  • Fully percutaneous transfemoral simultaneous transcatheter valve replacement (STVR) is a feasible and promising option for patients with native multivalvular heart disease (MVHD), specifically aortic regurgitation and mitral stenosis.
  • Meticulous understanding of both pathologies and precise procedural planning are mandatory for successful STVR.
  • This case report supports the potential of STVR to offer a minimally invasive alternative with likely shorter recovery times for complex MVHD patients.

Keywords:
Aortic regurgitationMitral stenosisMultivalvular heart diseaseSimultaneous transcatheter valve replacementTranscatheter aortic valve replacementTranscatheter mitral valve replacement

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