Live Hemodynamics-Assisted Simultaneous Aortic and Mitral Valve-in-Valve Replacement

Bioprosthetic valve failure is a growing challenge, particularly in high-risk patients who are poor surgical candidates. Simultaneous valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve replacement (TMVR) via a fully percutaneous approach remains a novel and evolving strategy with limited data. A 70-year-old man with failed aortic and mitral bioprostheses leading to severe intraprosthetic regurgitation presented with progressive heart failure symptoms. Owing to high surgical risk, he underwent transfemoral ViV-TAVR and transeptal ViV-TMVR using the SavvyWire for real-time hemodynamic monitoring and dedicated left ventricular pacing. The procedure was successful, with immediate hemodynamic improvement and no complications. This case demonstrates the feasibility, safety, and efficiency of simultaneous transfemoral ViV-TAVR and ViV-TMVR in high-risk patients with bioprosthetic valve failure. Although further data are needed, this case highlights a novel application of the SavvyWire, demonstrating its potential to enhance procedural precision, enable real-time hemodynamic assessment, and improve safety in simultaneous ViV-TAVR and ViV-TMVR.