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Successful Tavi in Patients with Previous Mitral Valve Replacement

Background: Transcatheter aortic valve implantation (TAVI) is a 
new method for patients with severe aortic stenosis at high surgical risk, such 
as previous cardiac surgery. The presence of mechanical mitral prosthesis might 
complicate TAVI because of possible interference between both prostheses. Some 
reports have already demonstrated the feasibility of TAVI in such patients. Case Reports: We report 2 patients with severe symptomatic aortic 
stenosis who had prior mitral valve replacement that successfully underwent 
TAVI with Edwards Sapien and CoreValve aortic prosthesis, re- spectively. Computed 
tomographic angiography (CTA) was 
useful for the assessment of the distance between both aor- tic and mitral 
prosthesis annuli. Transesophageal echocardiography was crucial for precise 
positioning of TAV. There were no special technical tips besides precise 
positioning of the valve prosthesis. In case of Core Valve the goal was the 
positioning at “zero point” and in case of Edwards Sapien valve a 
“half-on-half” position according to natural aortic valve. We observed no 
deformation or dysfunction of aortic and mitral prosthesis in any of the 
patients. Balloon valvu- loplasty prior to implantation helps to observe the 
mutual effect of the new aortic valve and pre-existent mitral prosthe- sis. Conclusions: We conclude that TAVI can be 
safely and successfully performed in patients with mechanical mitral prosthesis 
carefully considering the altered anatomical conditions. Skillfulness and TAVI 
experience of the operators should not be neglected.