Transcatheter aortic valve implantation after previous mechanical mitral valve replacement in a patient with coexistent rheumatic aortic stenosis and regurgitation

Abstract Background Reoperations are required frequently after the Ross procedure in rheumatic patients. The use of transcatheter aortic valve implantation (TAVI) in those patients could decrease the risk of future open procedure; however, the outcome may be affected by the concomitant mitral valve disease, and subsequent mitral reoperation may distort the implanted aortic valve. Case presentation We present a female patient who had a beating mitral valve replacement after valve-in-valve TAVI in a patient with prior Ross procedure. Weaning from cardiopulmonary bypass was difficult, and the patient needed extra-cardiac membrane oxygenation (ECMO) and intra-aortic balloon pump because of right ventricular dysfunction. The right ventricular dysfunction could be due to the concomitant coronary artery disease or air embolism during the beating mitral valve surgery. Recovery was gradual, and the patient was discharged after 33 days. Pre-discharge echocardiography showed a maximum gradient of 9 mmHg on the aortic valve and mild paravalvular leak. Conclusions Mitral valve replacement in a patient with prior TAVI and the Ross procedure was feasible; it decreased the operative risk and did not distort the implanted aortic valve.

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TCT-131: Transfemoral Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Patients Severe Aortic Stenosis

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2011.10.147 ◽

2011 ◽

Vol 58 (20) ◽

pp. B38

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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Severe aortic stenosis in the young, with or without bicuspid valve: is transcatheter aortic valve implantation the first choice?

European Heart Journal Supplements ◽

10.1093/eurheartj/suaa123 ◽

2020 ◽

Vol 22 (Supplement_L) ◽

pp. L1-L5

Author(s):

Igor Belluschi ◽

Nicola Buzzatti ◽

Alessandro Castiglioni ◽

Michele De Bonis ◽

Matteo Montorfano ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Implantation ◽

Surgical Risk ◽

Transcatheter Aortic Valve ◽

First Choice ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract During the last decade, transcatheter aortic valve implantation (TAVI) has represented a valid alternative to surgical aortic valve replacement in patients with aortic stenosis and elevated surgical risk. Recent randomized clinical trials reported excellent results also for patients at low surgical risk, but in clinical practice, the mean age of the patients treated remain over 75 years, and the presence of a bicuspid aortic valve still represents an important exclusion criteria. Today, aortic valve replacement with a mechanical prosthesis remains the treatment of choice for young adults with aortic stenosis, although the desire to avoid oral anticoagulants drives more patients younger than 65 years of age towards biological prostheses. Furthermore, despite the follow-up of patients after TAVI is still limited to a few years, the opportunity of a second percutaneous treatment (TAVI-in-TAVI), extends the scope of percutaneous strategy. In the next few years, TAVI has to face many challenges to become a valid alternative to surgery in the younger patients as well.

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