Management of giant left atrial thrombus late after Transcatheter Mitral Valve-in-ring Replacement using a Transcatheter Aortic Valve

Abstract In symptomatic high-risk patients with severe mitral valve regurgitation (MR), who are not eligible for surgery due to multimorbidity, and further do not fulfill the criteria for a Transcatheter edge-to-edge repair procedure (TEER, e.g., using the MitraClip™ system), transcatheter mitral valve replacement (TMVR) may be considered (IIb C) according to current guidelines. Since patients with severe MR due to failing biological mitral valve prostheses are never eligible for TEER and patients after surgical mitral valve repair are sometimes not eligible for TEER, TMVR using transcatheter aortic valve prosthesis has been successfully performed in smaller patient cohorts using both, the transapical as well as the transvascular access route. Due to that limited experiences and outcome data, there is currently no guideline recommendation for these special situations.