Strategic Prosthesis Selection for Staged TAVI and Minimally Invasive Mitral Valve Surgery in a High-Risk Patient.

BACKGROUND

In high-risk patients with complex aorto-mitral pathologies, surgical planning must carefully consider both current and future procedural needs. When traditional double-valve surgery poses prohibitive risks, a staged approach (initial transcatheter aortic valve implantation [TAVI]) followed by endoscopic minimally invasive mitral valve surgery (MIC-MVS) can be an alternative.

CASE HISTORY: A 65-year-old female patient with severe aortic stenosis and mitral stenosis underwent TAVI. Minimally invasive mitral valve surgery was planned 6 weeks later. During surgery, the high-profile TAVI prosthesis prevented sufficient aortic cross-clamping, leading to procedural adjustments and an extended intensive care unit recovery.

DISCUSSION: This case emphasizes the importance of careful prosthesis selection in staged procedures. The complication of an obstructed aortic cross-clamp due to high-implanted, high-profile transcatheter prosthesis illustrates how prosthesis choice can significantly affect subsequent surgeries. Interdisciplinary collaboration between surgeons and cardiologists is essential to anticipate such issues and ensure optimal patient outcomes.