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

## TL;DR

A patient in cardiogenic shock successfully underwent a combined aortic and mitral valve replacement in a single procedure without general anesthesia.

## Contribution

This is the first reported case of combined aortic and mitral valve-in-valve implantation under sedation in a patient with cardiogenic shock.

## Key findings

- Combined aortic and mitral valve-in-valve implantation was successfully performed in a single session under sedation.
- The patient had no cardiovascular events at 4 years of follow-up.
- The procedure appears safe for hemodynamically unstable patients without general anesthesia.

## Abstract

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

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.

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.

In hemodynamically unstable patients, this procedure appears to be safe even without use of general anesthesia.