title: First successful transcatheter double valve replacement from a transapical access and nine-month follow-up.
abstract: OBJECTIVE
  While TAVI is the treatment of choice in patients with aortic stenosis considered inoperable or at high risk, interventional replacement of the mitral valve is still in the preclinical or early clinical phase. Our aim was to report on the first transcatheter double valve replacement into native valves from a transapical access.
  
  
  RESULTS
  A 67-year-old, highly symptomatic female patient considered inoperable due to severe calcification of the mitral annulus and comorbidities was scheduled for transcatheter double valve replacement by the local Heart Team. Preoperative planning was carried out by multiplanar reconstruction from cardiac CT. Through a transapical access, the mitral valve was replaced first by an inverted 29 mm Edwards SAPIEN 3 prosthesis, then the aortic valve by a 23 mm SAPIEN 3, both during rapid pacing. Both prostheses revealed excellent function in angiography and echocardiography. The patient was extubated early after surgery and transferred to the normal ward the following day. After five months, she exhibited signs of cardiac failure again. Migration of the mitral prosthesis was detected, and the mitral valve was replaced surgically.
  
  
  CONCLUSIONS
  Transcatheter double valve replacement can be performed through a transapical access. The key to success is thorough preoperative planning based on CT, not only for sizing, but also for estimating the anatomical relationship of the prostheses. However, late migration can be expected and may lead to LVOT obstruction.
authors.affiliation: Department of Cardiac Surgery, University of Ulm, Ulm, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Bauernschmitt
authors.forename: Stefan
authors.initials: S
authors.lastname: Bauer
authors.forename: Christian
authors.initials: C
authors.lastname: Liewald
authors.forename: Ramiz
authors.initials: R
authors.lastname: Emini
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Oechsner
authors.forename: Meinrad
authors.initials: M
authors.lastname: Beer
authors.forename: Ralf
authors.initials: R
authors.lastname: Sodian
authors.forename: Andreas
authors.initials: A
authors.lastname: Liebold
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D016896:Treatment Outcome