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Staged Transcatheter Treatment of Combined Aortic and Mitral Regurgitation: A Downstream Approach
Mauro Massussi1, Mariafrancesca Forquet2, Paolo Scurti2
1Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy.
Background:
Concomitant severe aortic (AR) and mitral regurgitation (MR) affects up to 25% of patients with aortic valve disease and portends poor prognosis. Evidence on a sequential downstream approach in native AR is limited.
Case Summary:
We report 4 patients with high surgical risk (mean age 82 years, Society of Thoracic Surgeons score >8) with severe AR and MR treated with transcatheter aortic valve replacement for native AR. In 2 patients with secondary MR, AR correction was followed by reverse remodeling and downstaging of MR from severe to moderate, avoiding mitral transcatheter edge-to-edge repair. In the remaining 2 patients, MR remained severe, and staged mitral transcatheter edge-to-edge repair was performed.
Discussion:
These cases support the hypothesis that MR etiology, rather than AR correction alone, determines whether MR regresses after isolated AR treatment.
Take-Home Message:
MR etiology and post-transcatheter aortic valve replacement reassessment may guide a staged transcatheter strategy, sparing unnecessary mitral intervention in inoperable patients with combined AR/MR.