Key result
FLOWer cerebral embolic protection enables stroke-free transseptal mitral valve-in-valve implantation despite LAA thrombus.
Why the study?
Left atrial appendage thrombosis is generally considered a relative contraindication to transseptal mitral valve-in-valve implantation because of thromboembolic risk, leaving high-risk patients with degenerated mitral bioprostheses without viable surgical alternatives.
Case Report (n=1)
Transseptal mitral valve-in-valve implantation with cerebral embolic protection may be feasible and safe in highly selected patients with persistent left atrial appendage thrombosis and prohibitive surgical risk.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for mitral valve-in-valve with LAA thrombosis; challenges contraindications but leaves open need for trials.
BACKGROUND: Transcatheter mitral valve-in-valve (ViV) implantation is an alternative to redo surgery in high-risk patients with degenerated mitral bioprostheses. CASE SUMMARY: An elderly woman presented with recurrent acute pulmonary edema due to severe stenosis of a degenerated mitral bioprosthesis. Redo surgery was considered prohibitive (EuroSCORE II: 15%). Transesophageal echocardiography revealed persistent left atrial appendage (LAA) thrombosis despite appropriate anticoagulation, increasing embolic risk. Given severe symptoms and lack of viable alternatives, transseptal mitral ViV implantation was successfully performed using the FLOWer cerebral embolic protection device, without neurological complications and with excellent hemodynamic results. DISCUSSION: LAA thrombosis is generally considered a relative contraindication to transseptal mitral interventions because of thromboembolic risk. This case highlights the potential role of cerebral embolic protection and individualized heart team decision-making in highly selected patients. TAKE-HOME MESSAGE: Mitral ViV implantation with cerebral embolic protection may be feasible in selected patients with LAA thrombosis and prohibitive surgical risk.
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Pecci et al. (2026) conducted a case report in Severe stenosis of a degenerated mitral bioprosthesis with persistent left atrial appendage thrombosis (n=1). Transseptal mitral valve-in-valve implantation with FLOWer cerebral embolic protection device was evaluated on Procedural success, neurological complications, and hemodynamic results. Transseptal mitral valve-in-valve implantation using FLOWer cerebral embolic protection succeeded without neurological complications in a patient with LAA thrombosis.
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