title: A staged approach to transcatheter aortic valve implantation and mitral valve-in-valve implantation for a degenerated bioprosthesis in a high-risk patient.
abstract: Recently, small case series have described the successful off-label use of transcatheter valve implantation in patients with degenerated bioprosthetic valves in the mitral position. We report here the case of a 78-year old female patient who underwent transcatheter aortic valve implantation for severe aortic stenosis and transapical valve-in-valve implantation for a degenerated mitral bioprosthesis. There was no evidence of intraprosthetic regurgitation and/or paraprosthetic leakages on control angiography and transoesophageal echocardiography. The postoperative course was uneventful. Following accurate patient selection and evaluation by an experienced multidisciplinary team, the transcatheter approach to double-valve implantation in the aortic and mitral positions may represent a viable treatment option for those high-risk patients who would otherwise be inoperable. We preferred a two-step approach, considering a single procedure to be high-risk.
authors: Department of Cardiac Surgery,  Klinikum Nürnberg, Nuremberg,  Germany.
authors: Giuseppe
authors: G
authors: Santarpino
authors: Theodor
authors: T
authors: Fischlein
authors: Giovanni
authors: G
authors: Concistrè
authors: Steffen
authors: S
authors: Pfeiffer
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D018579:Patient Selection; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome