{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:58:14Z","timestamp":1760162294828,"version":"build-2065373602"},"reference-count":22,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T00:00:00Z","timestamp":1705276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Augsburg University, Germany"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>In this bicentric study, we report the outcomes of combined transcatheter aortic valve replacement combined with minimally invasive mitral valve surgery. We included a cohort of six patients (79.6 \u00b1 3.2 years, 83% women) with high-risk profiles and deemed to be non-operable with combined mitral and aortic valvular disease. All patients had unsuitable anatomies for transcatheter mitral valve edge-to-edge repair (TEER). Moreover, most of the patients (5\/6) suffered a combined aortic valve lesion, which complicates the efficiency of cardioplegia in the case of CBP through minimally invasive incisions. The first stage was implanting a TAVI valve to achieve aortic valve competency and hence facilitate the infusion of cardioplegia after clamping the aorta during endoscopic mitral valve surgery. After one week, we performed the minimally invasive mitral valve repair. Most patients (n = 5; 83%) underwent successful endoscopic mitral valve repair. Intraoperatively, the mean ischemic time was 42 min, and the total bypass time was 72 min. Postoperatively, the mean intubation time was 0 h. Postoperative complications included reoperation for bleeding in one patient (16.7%) and a new heart block requiring pacemaker implantation in one patient (16.7%). There was neither in-hospital mortality nor 1-year mortality.<\/jats:p>","DOI":"10.3390\/jcm13020471","type":"journal-article","created":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T07:25:07Z","timestamp":1705303507000},"page":"471","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Transcatheter Aortic Valve Replacement as a bridge to minimally invasive endoscopic mitral valve surgery in Elderly Patients in the era of ERAS and Fast Track TAVI concepts"],"prefix":"10.3390","volume":"13","author":[{"given":"Tamer","family":"Owais","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Augsburg, 86156 Augsburg, Germany"},{"name":"Department of Cardiothoracic Surgery, Cairo University, Giza P.O. Box 12613, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osama","family":"Bisht","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Regiomed Klinikum Coburg, 3396450 Coburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9810-0860","authenticated-orcid":false,"given":"Emre","family":"Polat","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Augsburg, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noureldin","family":"Abdelmoteleb","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Augsburg, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad","family":"El Garhy","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Helios Clinic Erfurt, 99089 Erfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phillip","family":"Lauten","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Kuntze","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evaldas","family":"Girdauskas","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Augsburg, 86156 Augsburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s40140-021-00455-4","article-title":"Enhanced Recovery After Cardiac Surgery: Where Do We Stand?","volume":"11","author":"Gebauer","year":"2021","journal-title":"Curr. Anesthesiol. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1000310","DOI":"10.4172\/2329-9517.1000310","article-title":"Predictors of Successful Fast Track Protocol in Transfemoral Transcatheter Aortic Valve Implantation Under General Anaesthesia","volume":"6","author":"Owais","year":"2018","journal-title":"J. Cardiovasc. Dis. Diagn."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1056\/NEJMoa1009355","article-title":"Percutaneous Repair or Surgery for Mitral Regurgitation","volume":"364","author":"Feldman","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"957","DOI":"10.4244\/EIJ-D-22-00725","article-title":"Mitral valve transcatheter edge-to-edge repair","volume":"18","author":"Hausleiter","year":"2023","journal-title":"EuroIntervention"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.jcin.2023.01.010","article-title":"Contemporary Outcomes Following Transcatheter Edge-to-Edge Repair","volume":"16","author":"Kar","year":"2023","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/S0195-668X(03)00201-X","article-title":"A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease","volume":"24","author":"Iung","year":"2003","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1016\/S0022-5223(02)73225-X","article-title":"Mitral valve repair with aortic valve replacement is superior to double valve replacement","volume":"125","author":"Gillinov","year":"2003","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_8","first-page":"e35","article-title":"2020 ACC\/AHA Guideline for the Management of Patients with Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"ref_9","first-page":"1194","article-title":"Concomitant mitral annular calcification and severe aortic stenosis: Prevalence, characteristics and outcome following transcatheter aortic valve replacement","volume":"38","author":"Abramowitz","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"jeaa356.363","DOI":"10.1093\/ehjci\/jeaa356.363","article-title":"Low-gradient aortic stenosis in patients with concomitant mitral regurgitation\u2014A subgroup analysis from the German aortic valve registry (GARY)","volume":"22","author":"Alushi","year":"2021","journal-title":"Eur. Heart J Cardiovasc. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1016\/j.jacc.2013.08.1621","article-title":"The complex nature of discordant severe calcified aortic valve disease grading: New insights from combined Doppler echocardiographic and computed tomographic study","volume":"62","author":"Clavel","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Patzelt, J., Ulrich, M., Becker, A., M\u00fcller, K.A.L., Jorbenadze, R., Droppa, M., Zhang, W., Mandel, S., Habel, L., and Lausberg, H. (2018). Previous TAVR in patients undergoing percutaneous edge-to-edge mitral valve repair (PMVR) affects improvement of MR. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0205930"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1186\/s13019-022-01904-9","article-title":"Outcome of patients with double valve surgery between 2009 and 2018 at University Hospital Basel, Switzerland","volume":"17","author":"Egger","year":"2022","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/imi.0000000000000028","article-title":"Outcome characteristics of multiple-valve surgery: Comparison with single-valve procedures","volume":"9","author":"Vassileva","year":"2014","journal-title":"Innov. Technol. Tech. Cardiothorac. Vasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2185","DOI":"10.1111\/jocs.14734","article-title":"Transcatheter aortic valve implantation and its impact on mitral valve geometry and function","volume":"35","author":"Meyer","year":"2020","journal-title":"J. Card. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1080\/24748706.2020.1740365","article-title":"The Impact of Self-Expandable Transcatheter Aortic Valve Replacement on Concomitant Functional Mitral Regurgitation: A Comprehensive Engineering Analysis","volume":"4","author":"Caballero","year":"2020","journal-title":"Struct. Heart J. Heart Team"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/s13019-020-01242-8","article-title":"Health-related quality of life following minimally invasive totally endoscopic mitral valve surgery","volume":"15","author":"Huang","year":"2020","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1177\/1457496920987427","article-title":"Combined Mitral and Aortic Valve Surgery: 17-year Experience in a Single Center","volume":"110","author":"Husso","year":"2021","journal-title":"Scand. J. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"274","DOI":"10.23736\/S0021-9509.17.09864-0","article-title":"Cardiopulmonary bypass time: Every minute counts","volume":"59","author":"Madhavan","year":"2018","journal-title":"J. Cardiovasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"550","DOI":"10.4187\/respcare.04915","article-title":"Prolonged Mechanical Ventilation as a Predictor of Mortality After Cardiac Surgery","volume":"63","year":"2018","journal-title":"Respir. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e008440","DOI":"10.1161\/JAHA.117.008440","article-title":"Incidence of Long-Term Structural Valve Dysfunction and Bioprosthetic Valve Failure after Transcatheter Aortic Valve Replacement","volume":"7","author":"Barbanti","year":"2018","journal-title":"J. Am. Heart. Assoc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.jcin.2019.07.049","article-title":"Long-Term Durability of Transcatheter Heart Valves: Insights From Bench Testing to 25 Years","volume":"13","author":"Sathananthan","year":"2020","journal-title":"JACC Cardiovasc Interv."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/2\/471\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:46:53Z","timestamp":1760104013000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/2\/471"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,15]]},"references-count":22,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["jcm13020471"],"URL":"https:\/\/doi.org\/10.3390\/jcm13020471","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2024,1,15]]}}}