One-stage transcatheter aortic valve replacement and transcatheter edge-to-edge repair for aortic and mitral regurgitation.

Abstract

An 84-year-old female was presented with shortness of breath and cough. Transthoracic echocardiography indicated severe aortic and mitral regurgitation, with a left ventricular ejection fraction of 59% and a left ventricular end-diastolic diameter of 61 mm. The symptom and grade of valvular regurgitation were not improved with 6-month optimal medical treatment. Due to the relatively high risk of double valve surgery for the octogenarian patient and patient preference for a minimally invasive procedure, one-stage transapical transcatheter aortic valve replacement (TAVR) and transcatheter edge-to-edge repair (TEER) was planned. The intraoperative transoesophageal echocardiography confirmed severe aortic and mitral regurgitation (Panels A and B). First, transapical TAVR was performed under fluoroscopic guidance (Panel C and Supplementary data online, Video S1) using a 25 mm J-Valve (JieCheng Medical) (Panel H) as previously described,1 with a postoperative mean pressure gradient of 3 mmHg. After TAVR, the grade of mitral regurgitation was still severe (Panel D). Subsequently, the same access route was used to perform TEER with ValveClamp (Hanyu Medical) (Panel I).2 Under the guidance of transoesophageal echocardiography, one clamp was implanted at A2 and P2 (Panels E and F), with a postoperative mean pressure gradient of 2 mmHg. Both aortic and mitral regurgitation reduced to trace postoperatively (Panel G and Supplementary data online, Video S2). The patient recovered uneventfully and was discharged 6 days later. During the 1-month follow-up, there was no evidence of valve insufficiency and heart failure.