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Simultaneous double valve in valve TAVI procedure for failed bioprosthesis in aortic and mitral position
Markus Schlömicher, Peter Lukas Haldenwang, Vadim Moustafine, Matthias Bechtel, Justus Thomas Strauch.
Ruhr-University Hospital Bergmannsheil, Bochum, Germany.

OBJECTIVE: A 78 years old female patient had undergone double valve replacement in 2010 - using a 27mm Medtronic Mosaic Bioprosthesis in mitral position - and a 25mm Medtronic Mosaic Bioprosthesis in aortic position. Concomitant bypass surgery with a LIMA-LAD bypass and one venous bypass on the marginal branch had also been performed.
Actually in 2014 the patient showed severe grade IV Dyspnea. Structural valve deterioration of both prostheses with mitral stenosis and a mean transvalvular gradient of 18mmHg, as well as severe aortic insufficiency could be verified echocardiographically
METHODS: With regards to these findings and the elevated risk in re-operation setting, the decision was taken to perform a transapical valve in valve TAVI procedure in mitral and aortic position simultaneously.
RESULTS: Postprocedural transesophageal echo could not detect any paravalvular leakage nor any aortic or mitral insufficiency. A mean transvalvular gradient of 20mmHg for the aortic prosthesis and a mean transvalvular gradient of 6mmHg for the mitral prosthesis could be measured. The postoperative course was uneventful, the patient was extubated 6 hours after the TAVI procedure. No bleeding occurred and the patient was transferred to ward on POD 1.
The patient was retransferred to referring hospital on POD 13.
CONCLUSIONS: This case shows the feasibility of double valve interventions using the transapical approach.

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