Trans-aortic Mitral Valve Repair and Aortic Valve Replacement with Rapid Deployment Prostheses in High Risk Patients

Abstract

Objective: To report a case of trans-aortic mitral valve repair and aortic valve replacement with rapid deployment prosthesis in a high risk patient. Methods: A 79 year-old female underwent trans-aortic mitral valve repair and aortic valve replacement with rapid deployment prosthesis. Her past medical history revealed hypertension, COPD and diabetes. She was referred to our center for the worsening of dyspnea on exertion. Trans-thoracic echocardiogram showed a severe aortic regurgitation and moderate mitral regurgitation. The mechanism of mitral insufficiency was the chordal rupture of the scallop A2 while aortic valve was calcified. Ejection fraction was 45%. She was a very fragile patient with a intermediate surgical risk profile (Euroscore II: 6.6%). Results: After removing the calcified aortic valve, we carried out a trans-aortic mitral valve repair by cutting the two ruptured chords on A2 and performing an edge-to-edge plasty between A2 and P2. Afterwards, we implanted a rapid deployment aortic prosthesis. This approach allowed us to reduce the CPB and aortic cross clamp times. Post-operative TTE showed trivial mitral regurgitation and no aortic paravalvular leaks. The patient was in-hospital discharged by a week. Conclusions: In high risk patients suffering from mitro-aortic disease our approach could be safe and easy.