Bailout transcatheter mitral valve implantation for extensive valvular and atrial calcifications during triple-valve surgery in a patient with long-lasting renal replacement therapy: a case report

Background We present a successful case of triple-valve surgery, including bailout open-heart transcatheter mitral valve implantation, in a hemodialysis patient with extensive intracardiac calcifications. Case summary A middle-aged woman with exercise-induced dyspnea and an end-stage kidney disease on renal replacement therapy was admitted to the emergency department for severe hypotension and bradycardia. A high-degree AV block was diagnosed. Multimodal imaging exams also revealed a triple severe valvular disease (mitral stenosis, aortic stenosis, and tricuspid regurgitation) with an unclear cardiac mass enclosed within the left atrial wall. To avoid potentially dangerous decalcification for valve replacement, a combined traditional surgical approach and transcatheter valve implantation have been successfully applied. Discussion The current case confirms that open-heart transcatheter valve implantation at the mitral position in the presence of marked calcifications involving the valve apparatus, atrial, and ventricular walls is a valuable option potentially avoiding dangerous decalcification, achieving effective mitral valve stenosis relief, and shortening surgical times.