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<p>Endoscopic Endoclampassisted MViV can expand the armamentarium for complex redo mitral surgery, offering excellent early clinical and haemodynamic results in selected patients. A 50 year-old man with heavy alcohol and tobacco use and two previous mitral operations (repair, then bioprosthetic replacement eight years earlier) presented with progressive dyspnoea (NYHA III). Transthoracic and transoesophageal echocardiography revealed severe mixed stenosis/regurgitation of a 33&#xa0;mm Medtronic Mosaic bioprothesis. No endocarditis was found preoperatively. After shared decisionmaking, minimally invasive videoassisted right minithoracotomy under endoaortic balloon occlusion (Endoclamp<sup>®</sup>) was planned. Intraoperatively, the degenerated valve was firmly embedded in the native annulus and could not be safely explanted. A 29&#xa0;mm SAPIEN&#xa0;3&#xa0;Ultra transcatheter heart valve was therefore deployed inside the surgical frame under direct vision on cardiopulmonary bypass (CPB). Postdeployment echocardiography showed a mean gradient of&#xa0;8&#xa0;mmHg without paravalvular leak or LVOT compromise. The patient was extubated on postoperative day&#xa0;2; aside from temporary difficulties in respiratory weaning, recovery was uneventful, and he was discharged home on day&#xa0;9.</p>

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Valve–in–valve transcatheter mitral valve replacement via totally endoscopic endoclamp–assisted approach after failed bioprosthetic mitral valve: a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月29日

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  • J. Nader,
  • A. Roussiaux,
  • J. E. Ricci,
  • C. Piot

摘要

Endoscopic Endoclampassisted MViV can expand the armamentarium for complex redo mitral surgery, offering excellent early clinical and haemodynamic results in selected patients. A 50 year-old man with heavy alcohol and tobacco use and two previous mitral operations (repair, then bioprosthetic replacement eight years earlier) presented with progressive dyspnoea (NYHA III). Transthoracic and transoesophageal echocardiography revealed severe mixed stenosis/regurgitation of a 33 mm Medtronic Mosaic bioprothesis. No endocarditis was found preoperatively. After shared decisionmaking, minimally invasive videoassisted right minithoracotomy under endoaortic balloon occlusion (Endoclamp®) was planned. Intraoperatively, the degenerated valve was firmly embedded in the native annulus and could not be safely explanted. A 29 mm SAPIEN 3 Ultra transcatheter heart valve was therefore deployed inside the surgical frame under direct vision on cardiopulmonary bypass (CPB). Postdeployment echocardiography showed a mean gradient of 8 mmHg without paravalvular leak or LVOT compromise. The patient was extubated on postoperative day 2; aside from temporary difficulties in respiratory weaning, recovery was uneventful, and he was discharged home on day 9.