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

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.