Cardiogenic shock in a patient with combined severe aortic and mitral regurgitation treated by a totally percutaneous approach: a case report

TL;DR

A patient with severe heart valve issues and cardiogenic shock was successfully treated using a minimally invasive, entirely percutaneous approach.

Contribution

This case demonstrates the feasibility of a totally percutaneous treatment for combined severe aortic and mitral regurgitation in cardiogenic shock.

Findings

An 86-year-old patient with cardiogenic shock was stabilized using an Impella CP device via a trans-femoral approach.

Transcatheter edge-to-edge repair and aortic valve implantation successfully improved the patient's condition.

The patient was able to transition to a rehabilitation program following the interventions.

Abstract

Combined severe aortic regurgitation and severe mitral regurgitation is a condition associated with high mortality, where evidence, about proper management, is still scarce, especially in critical clinical conditions such as cardiogenic shock.

An 86-year-old female with severe aortic and mitral regurgitation was admitted due to acute pulmonary oedema, rapidly deteriorating in cardiogenic shock refractory to medical treatment. Haemodynamic stabilization was achieved only after implantation of an Impella CP, through a trans-femoral approach. Considering the prohibitive surgical risk, the mitral valve regurgitation was treated with a transcatheter edge-to-edge repair procedure, which allowed to successfully wean the patient from Impella. Subsequently, a transcatheter aortic valve implantation was performed. The patient’s clinical status improved to such a level that a rehabilitation program was successfully implemented.

Our report shows that an entirely percutaneous approach, to manage a combined severe aortic and mitral regurgitation, complicated by cardiogenic shock, is feasible and effective.

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