Transhepatic Access for Mitral Valve Replacement: Transhepatic Transseptal Mitral Valve-in-Valve

Transcatheter mitral valve-in-valve (ViV) has emerged as a less invasive alternative to redo open surgical mitral valve replacement in patients at high surgical risk and is usually performed using a transseptal route by femoral venous access. Rarely, this approach may not be feasible owing to venous occlusions or congenital inferior vena cava (IVC) interruption.

A patient with agenesis of the femoral vein required a mitral ViV procedure, which was successfully done using transhepatic access.

Agenesis of the femoral vein is a rare malformation. The transhepatic route can be an alternative for structural procedures in these patients, albeit with technical challenges and additional risks.

Transhepatic access is a feasible alternative for transcatheter, transseptal procedures in patients with IVC interruption; however, special care must be taken to guarantee proper access for hemostasis. Hemorrhagic complications remain a concern in patients who undergo mitral ViV procedures owing to the need for anticoagulation therapy.