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

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.