Single Procedure of Transcatheter Aortic and Mitral Valve-in-Valve Implantation in a Patient With Cardiogenic Shock

Filippo Leidi; Simone Tresoldi; Ivan F Calchera; Matteo Pozzi; Giuseppe Trocino; Giovanni Marchetto; Maddalena Lettino; Pietro Vandoni; Stefano Righetti

doi:10.1016/j.jaccas.2025.104354

Single Procedure of Transcatheter Aortic and Mitral Valve-in-Valve Implantation in a Patient With Cardiogenic Shock

JACC Case Rep. 2025 Oct 22;30(33):104354. doi: 10.1016/j.jaccas.2025.104354.

Authors

Filippo Leidi¹, Simone Tresoldi¹, Ivan F Calchera¹, Matteo Pozzi², Giuseppe Trocino³, Giovanni Marchetto⁴, Maddalena Lettino⁵, Pietro Vandoni¹, Stefano Righetti⁶

Affiliations

¹ Interventional Cardiology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
² School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
³ Cardiovascular Diagnostics Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
⁴ Cardiac Surgery Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
⁵ Cardiothoracic and Vascular Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
⁶ Interventional Cardiology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy. Electronic address: stefano.righetti@irccs-sangerardo.it.

Abstract

Background: Transcatheter valve-in-valve (ViV) implantation is the treatment of choice for degenerated surgical bioprostheses, particularly in high-risk surgical patients.

Case summary: A 50-year-old man with severe dysfunction of a surgical aortic and mitral bioprosthesis rapidly developed cardiogenic shock. A dedicated computed tomography scan for ViV screening was not feasible owing to hemodynamic instability. Preprocedural screening was conducted using information from the ViV app, transesophageal echocardiography, and pulmonary computed tomography performed in the emergency department. A combined aortic and mitral ViV implantation was successfully performed in a single session under sedation. The patient was safely discharged and at 4 years of follow-up had not experienced any cardiovascular event.

Discussion: This case is the first report to our knowledge of a combined aortic and mitral ViV implantation performed under sedation in a patient in cardiogenic shock.

Take-home message: In hemodynamically unstable patients, this procedure appears to be safe even without use of general anesthesia.

Keywords: acute heart failure; aortic valve; mitral valve; pulmonary edema; valve replacement.

Publication types

Case Reports