Transcatheter valve replacement (TVR) improved the postoperative results of high risk patients.This less invasive option could be adopted to solve difficult and challenging cases.
We report a selection of 6 cases carachterized by difficult decision making, where a TVR was performed in full sternotomy (n = 2), transapical (n = 2) or percutaneously (n = 2).
Case 1. 72 years-old-female with malfunction of mitro-aortic bioprosthesis and severe post-capillary pulmonary hypertension.We performed aortic valve replacement, open mitral valve-in-valve(ViV)TVR and tricuspid valve annuloplasty.
Case 2. 79 years-old-male in cardiogenic shock due to bioprosthesis cusp rupture.We performed urgent transfemoral aortic valve replacement.
Case 3. 76 years-old-female with endocarditis on mitral bioprosthesis, admitted with acute pulmonary oedema.Because of sudden deterioration of hemodynamics refractory to inotropes, we performed urgent transapical ViVTVR.
Case 4. 54 years-old-female with Ebstein anomaly, endocavitary pace-maker and diagnosis of tricuspidalic bioprosthesis detachment. We performed trans-jugular tricuspidalic ViVTVR upon percutaneous removal of electrodes
Case 5. 77 years-old-female with rheumatic mitro-aortic stenosis. Because of extensive calcifications of valvular annuli, we perform open mitro-aortic replacement with aortic Sorin Solo and Edwards Sapien 3 mitral bioprosthesis.
Case 6. 84 years-old-female with previous aortic valve mechanical replacement (1982) and biological mitral replacement (1999). Admitted with acute mitral prosthesis malfunction due to cusp rupture, requiring intra-aortic balloon pump positioning. We performed urgent transapical ViVTVR.
All patients were discharged in good clinical conditions.
TVR may offer a feasible solution for extremely high risk patients, also in acute life-threatening valve disease.