2025 Volume 7 Issue 1 Pages 21-25
Purpose: We present a case of an underweight elderly woman with severe aortic stenosis and mitral regurgitation successfully treated with transcatheter aortic valve replacement (TAVR) through retroperitoneal approach and staged mitral valve transcatheter edge-to-edge repairment (M-TEER).
Case Presentation: The patient was a thin, 79-year-old woman who presented to our hospital with New York Heart Association functional classification (NYHA) class III heart failure symptoms. Her transthoracic echocardiography showed severe aortic stenosis (AS) and severe mitral regurgitation (MR). Her transesophageal echocardiography showed an MR jet emerging from the A2-P2 junction. First, our heart team planned to implement TAVR. Since her MR was a mixed type (atrial and degenerative) MR, there was a possibility that it could be treated with TAVR solely. However, in case MR remained, there was an indication for M-TEER, and her mitral valve configuration was feasible for the procedure. Weighing the risk of left ventricular systolic dysfunction and arrhythmia due to increased afterload, we decided to perform TAVR first and to proceed to M-TEER only if severe MR and heart failure symptoms persisted. Since the transfemoral approach was difficult due to her thin common femoral arteries, retroperitoneal approach was employed in TAVR. One month after dischawrge, she still had NYHA II heart failure symptoms, and transthoracic echocardiography showed severe MR, so we decided to perform M-TEER. Two months after TAVR, M-TEER was performed and Mitraclip G4 XTW (Abbott, Abbott Park, IL, USA) was implanted in the A2-P2 region. The patient’s postoperative course was favorable, and her subjective symptoms improved to NYHA I.
Conclusion: We experienced a case of severe aortic stenosis and mitral regurgitation successfully treated with TAVR through retroperitoneal approach and staged M-TEER.
