The presence of preexisting mitral prosthesis in transcatheter aortic valve replacement (TAVR) raises concerns about potential valve interaction; however, this issue remains insufficiently explored. A 79-year-old man presented with hemolysis 8 months post-TAVR. He had a history of mitral valve replacement 16 years prior. Further investigation revealed severe paravalvular leakage of the mitral valve, which was attributed to the dehiscence of the mitral prosthesis. A retrospective review of pre-TAVR computed tomography images identified a subtle, previously undetected defect in the mitral-aortic intervalvular fibrosa, likely masked by neointima. We hypothesize that chronic mechanical stress between the TAVR device and the mitral-aortic intervalvular fibrosa causes progressive damage, resulting in delayed mitral valve dehiscence and hemolysis. Careful preprocedural evaluation and prolonged postprocedural surveillance are essential for patients with preexisting mitral prostheses after TAVR due to the potential for delayed long-term complications.
Kim et al. (Fri,) studied this question.