Transapical Mitral TEER and Aortic Regurgitation TAVR With Dedicated Device in a Patient With Extreme Scoliosis

Abstract

Background Concomitant aortic and mitral regurgitation (CAMR) is a rare valvulopathy, seen in patients with scoliosis, and rarely involves aortic regurgitation with concomitant primary mitral regurgitation associated with poor prognosis when left untreated. Current guidelines lack robust evidence to guide the management of CAMR in complex anatomies such as extreme scoliosis. Case Summary We report the first case of a one-stage transcatheter intervention for CAMR in a 62-year-old man with extreme scoliosis. The patient underwent one-stage transapical mitral transcatheter edge-to-edge repair (mTEER) and on-label transcatheter aortic valve replacement to reduce surgical risk in high-risk patients. Despite significant anatomical challenges, the procedure was completed successfully without complications. Conclusion and Take-Home Messages CAMR in patients with severe scoliosis poses high operative risk, but a one-stage transapical approach using dedicated mTEER and transcatheter aortic valve replacement is a feasible, effective strategy. An mTEER-first strategy enables hemodynamic stabilization and precise leaflet grasping. This case underscores the value of individualized transcatheter strategies to achieve safe and effective outcomes in complex valvular disease.