Open Access

Emre Polat, Sina Stock, Tatiana Maria Sequeira-Gross, Fabian Emrich, Evaldas Girdauskas, Tamer Owais

• Background In high-risk patients with complex aorto-mitral pathologies, surgical planning must carefully consider both current and future procedural needs. When traditional double-valve surgery poses prohibitive risks, a staged approach (initial transcatheter aortic valve implantation [TAVI]) followed by endoscopic minimally invasive mitral valve surgery (MIC-MVS) can be an alternative. Case History A 65-year-old female patient with severe aortic stenosis and mitral stenosis underwent TAVI. Minimally invasive mitral valve surgery was planned 6 weeks later. During surgery, the high-profile TAVI prosthesis prevented sufficient aortic cross-clamping, leading to procedural adjustments and an extended intensive care unit recovery. Discussion This case emphasizes the importance of careful prosthesis selection in staged procedures. The complication of an obstructed aortic cross-clamp due to high-implanted, high-profile transcatheter prosthesis illustrates how prosthesis choice canBackground In high-risk patients with complex aorto-mitral pathologies, surgical planning must carefully consider both current and future procedural needs. When traditional double-valve surgery poses prohibitive risks, a staged approach (initial transcatheter aortic valve implantation [TAVI]) followed by endoscopic minimally invasive mitral valve surgery (MIC-MVS) can be an alternative. Case History A 65-year-old female patient with severe aortic stenosis and mitral stenosis underwent TAVI. Minimally invasive mitral valve surgery was planned 6 weeks later. During surgery, the high-profile TAVI prosthesis prevented sufficient aortic cross-clamping, leading to procedural adjustments and an extended intensive care unit recovery. Discussion This case emphasizes the importance of careful prosthesis selection in staged procedures. The complication of an obstructed aortic cross-clamp due to high-implanted, high-profile transcatheter prosthesis illustrates how prosthesis choice can significantly affect subsequent surgeries. Interdisciplinary collaboration between surgeons and cardiologists is essential to anticipate such issues and ensure optimal patient outcomes.…