Page 28 - Journal of Structural Heart Disease Volume 3, Issue 6

Case Report
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cal proximity of the two valves.
Edwards SAPIEN S3 was chosen as it is the only tran-
scatheter valve available that can be reverse-mount- ed to accommodate the transapical approach. Ad- ditionally, the SAPIEN 3 valve provides the option of balloon hyperexpansion if needed to minimize the risk of migration and paravalvular leak, especially in the mitral position. The sequence of valve implanta- tion is controversial. Salaun et al. [7] speculated that starting with mitral valve implantation may result in obstruction of the aortic prosthesis. Bauernschmitt et al. [5] chose to implant the mitral valve rst due to the anatomical proximity and concern for compression of the smaller aortic valve while implanting the larger mitral prosthesis. In Elkharbotly’s case [6], the aortic valve was placed rst. In our case, the aortic valve was implanted rst due to the critical nature of the aortic stenosis and in case of unexpected complications oc- curring during mitral valve intervention.
It is di cult to estimate the risk of mitral prosthesis migration. In the Bauernschmitt case [5], valve migra- tion was not noted before the patient died from ma- lignancy 9 months after implantation. In the Elkhar- botly case [6], the reported 6-month follow-up was
free of valve migration. Bapat et al. [8], in a valve-in- valve case, reported the migration of a SAPIEN pros- thesis from the mitral position. In our case, we decid- ed to hyperexpand the balloon in the mitral position to maximize valve xation and minimize the risk of migration. Hyperexpanding the mitral prosthesis may theoretically cause compression of the aortic valve or left ventricular out ow tract obstruction. Fortunate- ly, the postdeployment left ventricular out ow tract gradient was only 12 mmHg.
In conclusion, simultaneous TAVR and TMVR for native aortic and mitral valve stenosis may be safe in highly selected inoperable patients. The long-term safety and outcome of simultaneous TAVR and TMVR are not known, and more investigation is needed to validate this approach.
Con ict of Interest
The authors have no con ict of interest relevant to this publication.
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Cite this article as: Tandar A, Glotz- bach JP, Welt FG, Sharma V, Browning K, Selzman CH, Saidi A, Bull DA. Successful First-in-Man Concomitant Transapical Transcatheter Aortic and Mitral Valve Replacements for Severe Native Aor- tic and Mitral Valve Stenosis Using the Edwards Certitude Delivery System. Structural Heart Disease. 2017;3(6):180- 186. DOI: https://doi.org/10.12945/j. jshd.2017.026.17
Journal of Structural Heart Disease, December 2017
Volume 3, Issue 6:180-186