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Strategic Prosthesis Selection for Staged TAVI and Minimally Invasive Mitral Valve Surgery in a High-Risk Patient
Emre Polat1, Sina Stock1, Tatiana Maria Sequeira-Gross1
1Department of Cardiothoracic Surgery, University Hospital Augsburg, Augsburg, Germany.
JACC. Case Reports
|March 28, 2025
Summary
For high-risk patients, a staged approach using transcatheter aortic valve implantation (TAVI) followed by minimally invasive mitral valve surgery (MIC-MVS) is an option. Careful prosthesis selection is crucial to avoid complications in subsequent procedures.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Complex aorto-mitral pathologies necessitate careful surgical planning for high-risk patients.
- A staged approach, beginning with transcatheter aortic valve implantation (TAVI), offers an alternative to high-risk double-valve surgery.
- Endoscopic minimally invasive mitral valve surgery (MIC-MVS) can follow TAVI in a staged treatment strategy.
Observation:
- A 65-year-old female patient with severe aortic and mitral stenosis underwent TAVI.
- Minimally invasive mitral valve surgery was scheduled six weeks post-TAVI.
- The high-profile TAVI prosthesis obstructed aortic cross-clamping during the subsequent mitral valve surgery.
Findings:
- The choice of a high-profile TAVI prosthesis complicated the planned minimally invasive mitral valve surgery.
- Procedural adjustments and extended intensive care unit stay were necessitated by the complication.
- Prosthesis selection in staged cardiac procedures significantly impacts surgical feasibility and patient recovery.
Implications:
- Careful selection of TAVI prosthesis is critical to prevent complications in subsequent mitral valve interventions.
- Interdisciplinary collaboration between cardiac surgeons and interventional cardiologists is essential for optimizing staged treatment plans.
- Anticipating potential device interactions is key to successful management of complex aorto-mitral disease.
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