TAVI, VALVE IN MAC AND CLOSURE OF PARAVALVULAR LEAK IN AN INOPERABLE PATIENT

Particularity of the video: Multivalvular disease (MVD) still represents a challenging scenario. The first-choice treatment is usually open surgery, given the possibility of simultaneously treating all the involved valves. Nonetheless, patients’ clinical conditions are getting far worse, dramatically increasing the surgical risk and operative mortality. Therefore, a transcatheter approach may represent a safe alternative, though considering the burden of a high technical complexity. Brief description: We report the case of a 76-year-old female affected by severe aortic and mitral valve stenosis, presenting with acute heart failure (NYHA IV). Surgery was denied due to chronic myeloid leukemia, determining severe pancytopenia (platelet count 12000/mm3) and unfavorable anatomical characteristics, related to the extremely calcified mitral valve ring (MAC). A transcatheter approach was chosen, performing in a single-step procedure a TAVI, a TVMI-in- MAC and a subsequent paravalvular leak closure. The patient was eventually discharged and in good clinical conditions at 1 month follow-up.