Simultaneous transcatheter valve-in-valve replacement of severely degenerated bioprosthetic aortic and mitral prostheses

In patients who require surgical heart valve replacement, bioprosthetic heart valves (BHVs) are frequently utilized as the treatment of choice. As life expectancy is constantly growing, valve durability becomes more important and structural valve deterioration needs to be therapeutically addressed. Transcatheter aortic valve-in-valve replacement (ViV-TAVR) is increasingly considered for the treatment of patients with degenerated aortic valve prostheses. More recently, valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) has emerged as a treatment option for patients with symptomatic severely degenerated bioprosthetic valves with high risk for redo cardiac surgery [1]. Concomitant degeneration of aortic valve (AV) and mitral valve (MV) prostheses might occur more frequently as the population ages. In these patients, progressive structural valve deterioration of both valves may have cumulative effects on circulation and may rapidly cause severe congestive heart failure and left atrial thrombus formation. Currently, a considerable proportion of these patients are not suitable for redo cardiac surgery. Therefore, urgent simultaneous double valve replacement might be required. While previous investigators have reported simultaneous ViV-TAVR and ViV-TMVR in patients via a transapical access with balloon-expandable valves [2, 3], data on transfemoral access route with the optimal treatment strategy is limited. We report a case of successful transfemoral simultaneous ViV-TAVR and ViVTMVR in degenerated bioprosthetic valves. An 85-year-old male patient was presented with symptomatic dyspnea NYHA class IV and unstable angina to our emergency department. Clinical examination revealed signs of low forward cardiac output with pulmonary and * Matti Adam matti.adam@uk-koeln.de