Clinical Images

Double Trouble: Transapical Transcatheter Replacement of the Aortic and Mitral Valves in a Single Operation

Mohamad Lazkani, MD;  Joshua Waggoner, MD;  Michael Morris, MD;  George Gellert, MD;  Kenith Fang, MD;  Ashish Pershad, MD

Mohamad Lazkani, MD;  Joshua Waggoner, MD;  Michael Morris, MD;  George Gellert, MD;  Kenith Fang, MD;  Ashish Pershad, MD

J INVASIVE CARDIOL 2018;30(6):E54.

Key words: double-valve replacement, aortic valve replacement, mitral valve replacement

Patients with valvular heart disease often present with different combinations of valve dysfunction involving both the mitral and aortic valves. One common example is the presence of severe aortic stenosis and severe mitral regurgitation. In this setting, traditional teaching suggests treating the aortic valve first and observing the mitral valve because a significant percentage of patients improve their mitral regurgitation. A less common scenario is the presence of severe stenosis in both valves. Treatment of this combination of valve disease poses a clinical conundrum, for which no clear answers exist in the literature. Percutaneous intervention is well established for severe aortic stenosis, but data are limited for severe mitral stenosis. However, percutaneous mitral valve intervention with balloon-expandable valves in patients with severe mitral annular calcification is feasible, but may be associated with significant adverse events. This strategy might be an alternative for selected high-risk patients with limited treatment options.

A 63-year-old female presented with multiple comorbidities, including severe mitral stenosis and aortic stenosis, end-stage renal disease, and oxygen-dependent chronic obstructive pulmonary disease with a Society of Thoracic Surgery risk score of 12% for mitral valve replacement. She was considered at prohibitive risk for open double-valve surgery. Her symptoms were consistent with New York Heart Association class IV heart failure.

Simultaneous replacement of both valves was performed via transapical approach using a 23 mm Sapien-3 valve (Edwards Lifesciences) in the aortic position first, followed by deployment of a 26 mm Sapien-3 valve in the mitral position (Figure 1A, Video 1). Three-dimensional transesophageal echocardiogram (Figure 1B, Video 2) depicts the intricate relationship between the aortic and mitral valves and the anatomy of the aortomitral curtain. This case represents the first reported simultaneous transcatheter aortic and mitral valve replacement for native aortic and mitral stenosis performed via transapical approach.

From the University of Arizona – Banner University Medical Center Phoenix, Phoenix, Arizona.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted February 8, 2018. 

Address for correspondence: Mohamad Lazkani, MD, Department of Cardiology, Banner University Medical Center, University of Arizona, 750 E. McDowell Road, Phoenix, AZ 85006. Email: