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Innovative Transapical Approach for Double Aortic and Mitral Valve inValve Replacement A Case Study

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by

Vishnu
in

Introduction

Double valves-in-valves (VIV) replacement through a single transapical access is an emerging technique for high-risk patients with contraindications for transseptal access. This case study highlights the successful execution of a double VIV procedure under cerebral angiography control, ensuring minimized thrombus embolism risks.

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Case Summary

A 72-year-old male patient with a history of aortic and mitral bioprosthetic valve replacement in 2010 presented with severe dyspnea (NYHA Class IV). Diagnostic imaging confirmed stenotic bioprostheses and persistent left atrial thrombus despite optimal anticoagulation. Due to transseptal access contraindications, the heart team opted for a transapical double VIV replacement strategy.

Key Findings

  • Transapical VIV Procedure:
    • Aortic VIV implantation using Edwards Sapien 3 (26 mm).
    • Mitral VIV implantation using Edwards Sapien 3 (29 mm).
    • Cerebral angiography post-implantation confirmed no cerebral artery occlusion.
  • Right Ventricle Laceration Management:
    • Urgent ECMO implantation was successfully performed to stabilize the patient.
  • Follow-up Outcomes:
    • The patient was discharged symptom-free after 14 days.
    • At the 6-month follow-up, stable valve gradients and improved left ventricular ejection fraction (45%) were observed.

Clinical Implications and Expert Insights

According to the American College of Cardiology, managing high-risk valve replacement patients requires an interdisciplinary approach involving cardiologists, interventional radiologists, and neurologists to mitigate complications like thromboembolism and right ventricle trauma.

Read the Full Study

Explore the complete study at DOI: 10.29328/journal.jccm.1001042 for an in-depth analysis.

Further Reading

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