Valve-in-Valve Transcatheter Aortic Valve Replacement After a Valve-in-Valve Transcatheter Mitral Valve Replacement

BACKGROUND: Bioprosthetic valve failure is frequently treated with transcatheter therapies in high-surgical risk patients. Management of patients with concurrent bioprosthetic multivalvular dysfunction may require more complex decision-making and planning compared to those with isolated valve disease. CASE SUMMARY: An 84-year-old patient presented with symptomatic diastolic heart failure, with evidence of both mitral and aortic bioprosthetic valve failure on echocardiogram. He underwent sequential mitral and aortic valve-in-valve (ViV) procedures. DISCUSSION: This case highlights technical challenges and considerations for ViV transcatheter aortic valve replacement (TAVR) in patients with prior transcatheter mitral valve replacement (TMVR). TAKE-HOME MESSAGES: In patients with challenging left ventricular outflow tract anatomy, it is desirable to perform aortic ViV before mitral ViV procedures to minimize interaction of the TAVR system with the mitral prosthesis. In situations where the aortic ViV is performed after the mitral valve has been treated, anatomic challenges of a narrow left ventricular outflow tract and close proximity of the TMVR to the aortic valve can be overcome with careful procedural planning and advanced techniques.