Transcatheter Mitral Valve-in-Valve Replacement With Microaxial Flow-Pump Support for Bioprosthetic Valve Failure

BACKGROUND: Structural deterioration of bioprosthetic mitral valves is a common cause of late valve failure, requiring surgical or transcatheter replacement of the failed prosthesis. In rare cases, hemodynamic compromise may lead to cardiogenic shock, requiring mechanical circulatory support and making treatment particularly challenging. CASE SUMMARY: A 76-year-old man with prior bioprosthetic mitral valve replacement presented with cardiogenic shock. A microaxial flow pump was implanted. Echocardiography revealed severe transvalvular mitral regurgitation due to leaflet tear. Because of prohibitive surgical risk, the heart team opted for transcatheter mitral valve-in-valve replacement. The procedure resulted in immediate hemodynamic stabilization and weaning from mechanical support within 24 hours. DISCUSSION: This case demonstrates the feasibility of transcatheter mitral valve replacement combined with microaxial flow-pump support in cardiogenic shock as a potential rescue therapy in selected patients. TAKE-HOME MESSAGE: Timely transcatheter intervention may be life-saving in cardiogenic shock due to bioprosthetic mitral valve failure.