Long-Term Follow-Up After Dual Transcatheter Valve-in-Valve Implantation Under VA-ECMO Support

BACKGROUND: Cardiogenic shock due to simultaneous degeneration of multiple prosthetic valves is rare and is associated with prohibitive surgical risk. CASE SUMMARY: A 73-year-old woman with 3 prior sternotomies presented with acute decompensated heart failure, which rapidly progressed to cardiogenic shock after atrial fibrillation. Multimodality imaging demonstrated severe dysfunction of both aortic and mitral bioprostheses, with biventricular dysfunction. Refractory shock necessitated venoarterial extracorporeal membrane oxygenation (ECMO). Given extreme surgical risk, a transcatheter strategy was pursued. Sequential transfemoral aortic and transseptal mitral valve-in-valve implantations were successfully performed under ECMO support. Hemodynamics improved immediately, allowing ECMO explantation. At the 3-year follow-up, both valves demonstrated durable function with sustained clinical recovery. DISCUSSION: The increasing integration of mechanical circulatory support with rapidly evolving transcatheter valve technologies is enabling a new paradigm of complex and high-risk structural heart interventions. TAKE-HOME MESSAGE: Dual transcatheter valve-in-valve implantation is feasible and effective in selected patients on mechanical circulatory support.