Concomitant transfemoral aortic and mitral valve replacement

A 78-year-old male with mitral stenosis and concomitant aortic stenosis presented with progressive exertional dyspnoea (New York Heart Association [NYHA] Class III). His past medical history included rheumatic heart disease, permanent atrial fibrillation, and hyperlipidaemia. His Rockwood Clinical Frailty Scale score was 3, and he was on digoxin, warfarin, and simvastatin. Transthoracic echocardiography demonstrated a left ventricular ejection fraction of 40%, mildly reduced right ventricular systolic function, rheumatic mitral and aortic valve disease with severe mitral stenosis (mean gradient 5.5 mmHg, mitral valve area 0.91 cm²), mild mitral regurgitation (MR), and low-flow (Stroke Volume Index 34 ml/m²) severe aortic stenosis (AS) with a mean pressure gradient of 33 mmHg and an aortic valve area (AVA) of 1.0 cm² (0.42 cm²/m²). The mitral valve mean gradient increased to 10 mmHg at peak exercise with significant pulmonary hypertension (pulmonary artery systolic pressure >60 mmHg), without a change in the AVA. Non-contrast computed tomography (CT) revealed an aortic valve calcium score of 2,145 Agatston units, supporting the diagnosis of severe AS.

Percutaneous balloon mitral commissurotomy was considered high risk due to the patient having...