Transapical aortic valve implantation in the presence of a mitral prosthesis.

Transcatheter aortic valve implantation (TAVI), using the Edwards Sapien balloon expandable valve (Edwards Lifesciences, Irvine, California, USA) has expanded our ability to treat patients with symptomatic severe aortic stenosis, and become the treatment of the choice in high risk inoperable patients (1,2). Further inroads into its application in subgroup populations, such as patients with a functioning mitral valve prosthesis, has also been defined over recent years. With experience, these patients now need not be uniformly excluded (3). Our case series have demonstrated that the transapical TAVI of a balloon expandable valve is feasible and safe in patients with both mechanical and bioprosthetic mitral prostheses. Technical challenges however exist in patients with mitral bioprostheses (3). The understanding of the interaction between both prostheses at the anatomic aorto-mitral continuity is critical for patient selection, and procedural modification to ensure success.