Combining Minimally Invasive Mitral Valve Replacement with Kidney Transplantation: A Pioneering Case

BACKGROUND Cardiac valve disease is a major risk factor in patients undergoing kidney transplantation. Uncorrected mitral valve pathology in end-stage renal disease increases perioperative risk and can compromise renal graft outcomes. Traditional staged procedures increase the cumulative surgical burden. This report describes a case of combined cardiac and renal surgery performed during a single operative session. CASE REPORT A 42-year-old man with end-stage renal disease and severe symptomatic mitral regurgitation (grade 4/4) presented for evaluation. He experienced poor tolerance to dialysis and dyspnea attributed to volume overload. Transthoracic echocardiography revealed Carpentier class II posterior leaflet prolapse with central jet regurgitation. The patient underwent simultaneous mitral valve replacement via right mini-thoracotomy with peripheral cardiopulmonary bypass, followed by open extraperitoneal living-donor kidney transplantation in the right iliac fossa. Postoperative recovery was uneventful, with normalization of renal function and satisfactory prosthetic valve performance. Although previous reports have described simultaneous cardiac and renal surgeries, this is the first documented case of simultaneous minimally invasive mitral valve replacement combined with kidney transplantation; prior cases were performed through conventional sternotomy. The use of a minimally invasive cardiac approach resulted in reduced bleeding, absence of sternal wound complications, and no requirement for blood transfusion, providing important advantages in this combined surgical context. CONCLUSIONS This case demonstrates that simultaneous mitral valve replacement and kidney transplantation is feasible in selected high-risk patients. A combined approach may reduce total anesthetic exposure, avoid delay in transplantation, and facilitate early recovery.