Clinical outcomes of one-stage transcatheter aortic and mitral valve replacement in patients with combined valvular disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Ping ^1,2 , YAO Zhouwei ¹ , ZHU Enjun ² ,  TAN Tong ² ,  LAI Yongqiang ²

1. Department of Cardiovascular Surgery, Linyi Central Hospital, Linyi, 276400, Shandong, P. R. China;
2. Department of Structural Heart Disease Surgery, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, P. R. China;

Corresponding?author：

TAN Tong, Email: 23ttan@mail.ccmu.edu.cn; LAI Yongqiang, Email: laiyongqiang@126.com

Keywords：

Transcatheter aortic valve replacement; transcatheter mitral valve replacement; simultaneous procedure; hybrid intervention; combined valvular heart disease

DOI：

10.7507/1007-4848.202509055

Video：

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Objective To summarize and analyze the clinical outcomes of one-stage transcatheter aortic valve replacement (TAVR) combined with transcatheter mitral valve replacement (TMVR) in patients with concomitant severe aortic and mitral valve disease. Methods We retrospectively collected the clinical data of patients who underwent one-stage TAVR and TMVR at Beijing Anzhen Hospital between January 2019 and May 2025. Baseline characteristics, procedural details, and perioperative echocardiographic results were recorded. Survivors were followed regularly, and the incidence of major adverse cardiovascular and cerebrovascular events was assessed. Results A total of 12 high-risk patients with concomitant severe aortic and mitral valve disease were included, comprising 7 males with a mean age of (73.3±5.4) years. Aortic valve pathology included mixed lesions (n=1), aortic regurgitation (n=8), and aortic stenosis (n=3). Among them, 7 patients had previously undergone surgical bioprosthetic aortic valve replacement. Mitral valve pathology consisted of bioprosthetic valve degeneration leading to isolated regurgitation (n=8) or mixed lesions (n=4); 11 patients had a prior surgical bioprosthetic mitral valve replacement. All patients successfully underwent one-stage TAVR combined with TMVR, with 10 procedures performed via the transapical approach, 1 via the transfemoral approach, and 1 via a combined transfemoral-transapical approach. Valve deployment was successful in all cases, with an overall device success rate of 91.7%. The median intensive care unit stay was 1.5 (IQR 1.3, 3.4) d. Early postoperative complications included 2 perioperative deaths and 2 cases of gastrointestinal bleeding, with no other major cardiovascular events observed. During follow-up, there were no deaths, permanent pacemaker implantations, and no occurrences of moderate-to-severe valve stenosis, paravalvular leak, or left ventricular outflow tract obstruction. Conclusion This study demonstrates that one-stage TAVR combined with TMVR is safe and effective in selected high-risk patients with concomitant severe aortic and mitral valve disease, and represents a feasible therapeutic option.

1.	Asami M, Windecker S, Praz F, et al. Transcatheter aortic valve replacement in patients with concomitant mitral stenosis. Eur Heart J, 2019, 40(17): 1342-1351.
2.	VARC-3 Writing C, Genereux P, Piazza N, et al. Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. J Am Coll Cardiol, 2021, 77(21): 2717-2746.
3.	De Palma R, O'Sullivan CJ, Settergren M. Is there currently a place for combined mitral and aortic transcatheter interventions? Curr Cardiol Rep, 2019, 21(10): 129.
4.	Hu X, Ye Y, Li Z, et al. Primary regional disparities in clinical characteristics, treatments, and outcomes of a typically designed study of valvular heart disease at 46 tertiary hospitals in China: insights from the China-VHD Study. Chin Med J, 2025, 138(8): 937-946.
5.	Arshad HB, Minhas AMK, Khan SU, et al. National trends and outcomes of surgical aortic valve replacement with concomitant mitral valve surgery. Cardiovasc Revasc Med, 2022, 40: 13-19.
6.	Abdulla A, Jneid H. Transcatheter therapies for severe aortic and mitral stenosis: to stage or not to stage? Catheter Cardiovasc Interv, 2022, 100(5): 901-902.
7.	Ando T, Takagi H, Briasoulis A, et al. A systematic review of reported cases of combined transcatheter aortic and mitral valve interventions. Catheter Cardiovasc Interv, 2018, 91(1): 124-134.
8.	Pei J, Liu J, Guo H. Concomitant transapical transcatheter aortic valve replacement and transapical balloon mitral valvuloplasty to treat severe aortic stenosis with severe mitral stenosis. Heart Surg Forum, 2021, 24(4): E624-E627.
9.	譚桐, 朱恩軍, 崔顥, 等. 同期經心尖單切口行主動脈瓣置換術及二尖瓣緣對緣修復術1例. 中國臨床案例成果數據庫, 2024, 6(1): E2128.Tan T, Zhu EJ, Cui H, et al. A case of simultaneous transapical single-incision aortic valve replacement and mitral edge-to-edge repair. Chin Clin Case Achiev Database, 2024, 6(1): E2128.
10.	龔文輝, 韋小勇, 高曉天, 等. “一站式”經心尖經導管主動脈瓣置換術聯合二尖瓣緣對緣修復術治療多瓣膜病變的早期療效分析. 中國胸心血管外科臨床雜志, 2024, 31(10): 1467-1474.Gong WH, Wei XY, Gao XT, et al. Early outcomes of one-stop transapical transcatheter aortic valve replacement combined with mitral edge-to-edge repair for multiple valvular diseases. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(10): 1467-1474.
11.	魏培堅, 譚桐, 吳宏祥, 等. 合并中重度二尖瓣反流患者行經導管主動脈瓣置換術的研究進展. 中國胸心血管外科臨床雜志, 2022, 29(8): 938-944.Wei PJ, Tan T, Wu HX, et al. Advances in transcatheter aortic valve replacement in patients with moderate to severe mitral regurgitation. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(8): 938-944.
12.	Schl?milch M, Fikenzer S, Erdsack P, et al. Simultaneous double valve-in-valve TAVI procedure for failed bioprostheses. Ann Thorac Surg, 2015, 99(2): 722-724.
13.	Elbadawi A, Elgendy IY, Afify H, et al. Combined transcatheter aortic and mitral valve interventions: insights from a national database. JACC Cardiovasc Interv, 2021, 14(13): 1505-1507.
14.	Zajarias A, Kodali S, McCabe JM, et al. Real-world experience with concomitant or staged transcatheter aortic and mitral valve replacements using balloon-expandable valves. Catheter Cardiovasc Interv, 2022, 100(5): 890-900.
15.	Urena M, Vahanian A, Brochet E, et al. Current indications for transcatheter mitral valve replacement using transcatheter aortic valves: valve-in-valve, valve-in-ring, and valve-in-mitral annulus calcification. Circulation, 2021, 143(2): 178-196.
16.	Fukui M, Sorajja P, Cavalcante JL, et al. Deformation of transcatheter heart valve following valve-in-valve transcatheter aortic valve replacement: implications for hemodynamics. JACC Cardiovasc Interv, 2023, 16(5): 515-526.
17.	張海波, 潘湘斌, 郭應強, 等. 中國心臟二尖瓣生物瓣毀損介入瓣中瓣技術多中心專家建議. 中國胸心血管外科臨床雜志, 2024, 31(8): 1090-1095.Zhang HB, Pan XB, Guo YQ, et al. Multicenter expert consensus on transcatheter valve-in-valve technique for failed mitral bioprostheses in China. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(8): 1090-1095.

1. Asami M, Windecker S, Praz F, et al. Transcatheter aortic valve replacement in patients with concomitant mitral stenosis. Eur Heart J, 2019, 40(17): 1342-1351.
2. VARC-3 Writing C, Genereux P, Piazza N, et al. Valve Academic Research Consortium 3: updated endpoint definitions for aortic valve clinical research. J Am Coll Cardiol, 2021, 77(21): 2717-2746.
3. De Palma R, O'Sullivan CJ, Settergren M. Is there currently a place for combined mitral and aortic transcatheter interventions? Curr Cardiol Rep, 2019, 21(10): 129.
4. Hu X, Ye Y, Li Z, et al. Primary regional disparities in clinical characteristics, treatments, and outcomes of a typically designed study of valvular heart disease at 46 tertiary hospitals in China: insights from the China-VHD Study. Chin Med J, 2025, 138(8): 937-946.
5. Arshad HB, Minhas AMK, Khan SU, et al. National trends and outcomes of surgical aortic valve replacement with concomitant mitral valve surgery. Cardiovasc Revasc Med, 2022, 40: 13-19.
6. Abdulla A, Jneid H. Transcatheter therapies for severe aortic and mitral stenosis: to stage or not to stage? Catheter Cardiovasc Interv, 2022, 100(5): 901-902.
7. Ando T, Takagi H, Briasoulis A, et al. A systematic review of reported cases of combined transcatheter aortic and mitral valve interventions. Catheter Cardiovasc Interv, 2018, 91(1): 124-134.
8. Pei J, Liu J, Guo H. Concomitant transapical transcatheter aortic valve replacement and transapical balloon mitral valvuloplasty to treat severe aortic stenosis with severe mitral stenosis. Heart Surg Forum, 2021, 24(4): E624-E627.
9. 譚桐, 朱恩軍, 崔顥, 等. 同期經心尖單切口行主動脈瓣置換術及二尖瓣緣對緣修復術1例. 中國臨床案例成果數據庫, 2024, 6(1): E2128.Tan T, Zhu EJ, Cui H, et al. A case of simultaneous transapical single-incision aortic valve replacement and mitral edge-to-edge repair. Chin Clin Case Achiev Database, 2024, 6(1): E2128.
10. 龔文輝, 韋小勇, 高曉天, 等. “一站式”經心尖經導管主動脈瓣置換術聯合二尖瓣緣對緣修復術治療多瓣膜病變的早期療效分析. 中國胸心血管外科臨床雜志, 2024, 31(10): 1467-1474.Gong WH, Wei XY, Gao XT, et al. Early outcomes of one-stop transapical transcatheter aortic valve replacement combined with mitral edge-to-edge repair for multiple valvular diseases. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(10): 1467-1474.
11. 魏培堅, 譚桐, 吳宏祥, 等. 合并中重度二尖瓣反流患者行經導管主動脈瓣置換術的研究進展. 中國胸心血管外科臨床雜志, 2022, 29(8): 938-944.Wei PJ, Tan T, Wu HX, et al. Advances in transcatheter aortic valve replacement in patients with moderate to severe mitral regurgitation. Chin J Clin Thorac Cardiovasc Surg, 2022, 29(8): 938-944.
12. Schl?milch M, Fikenzer S, Erdsack P, et al. Simultaneous double valve-in-valve TAVI procedure for failed bioprostheses. Ann Thorac Surg, 2015, 99(2): 722-724.
13. Elbadawi A, Elgendy IY, Afify H, et al. Combined transcatheter aortic and mitral valve interventions: insights from a national database. JACC Cardiovasc Interv, 2021, 14(13): 1505-1507.
14. Zajarias A, Kodali S, McCabe JM, et al. Real-world experience with concomitant or staged transcatheter aortic and mitral valve replacements using balloon-expandable valves. Catheter Cardiovasc Interv, 2022, 100(5): 890-900.
15. Urena M, Vahanian A, Brochet E, et al. Current indications for transcatheter mitral valve replacement using transcatheter aortic valves: valve-in-valve, valve-in-ring, and valve-in-mitral annulus calcification. Circulation, 2021, 143(2): 178-196.
16. Fukui M, Sorajja P, Cavalcante JL, et al. Deformation of transcatheter heart valve following valve-in-valve transcatheter aortic valve replacement: implications for hemodynamics. JACC Cardiovasc Interv, 2023, 16(5): 515-526.
17. 張海波, 潘湘斌, 郭應強, 等. 中國心臟二尖瓣生物瓣毀損介入瓣中瓣技術多中心專家建議. 中國胸心血管外科臨床雜志, 2024, 31(8): 1090-1095.Zhang HB, Pan XB, Guo YQ, et al. Multicenter expert consensus on transcatheter valve-in-valve technique for failed mitral bioprostheses in China. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(8): 1090-1095.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesClinical outcomes of one-stage transcatheter aortic and mitral valve replacement in patients with combined valvular disease

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