Live Hemodynamics-Assisted Simultaneous Aortic and Mitral Valve-in-Valve Replacement

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Bioprosthetic Valve Technology

Background:

• Bioprosthetic valve failure presents a significant clinical challenge, especially in high-risk surgical patients.
• Transcatheter valve-in-valve (ViV) procedures, including ViV transcatheter aortic valve replacement (ViV-TAVR) and ViV transcatheter mitral valve replacement (ViV-TMVR), offer a less invasive alternative.
• Simultaneous percutaneous ViV-TAVR and ViV-TMVR is an emerging strategy with limited supporting data.

Observation:

• A 70-year-old male with severe intraprosthetic regurgitation due to failed aortic and mitral bioprostheses experienced progressive heart failure.
• The patient, deemed a high surgical risk, underwent a simultaneous transfemoral ViV-TAVR and transeptal ViV-TMVR.
• The procedure utilized the SavvyWire for real-time hemodynamic monitoring and left ventricular pacing.

Findings:

• The simultaneous ViV-TAVR and ViV-TMVR procedure was technically successful, leading to immediate hemodynamic improvement.
• No procedural complications were observed.
• The use of SavvyWire facilitated real-time hemodynamic assessment and enhanced procedural safety.

Implications:

• This case highlights the feasibility, safety, and efficiency of combined percutaneous ViV-TAVR and ViV-TMVR in high-risk patients.
• The SavvyWire demonstrates potential for improving precision and safety in complex, simultaneous transcatheter valve interventions.
• Further research is warranted to validate these findings in larger cohorts and establish this approach as a standard of care.