Work

Transhepatic Access for Mitral Valve Replacement

Year: 2025

Type: article

Abstract: BACKGROUND: Transcatheter mitral valve-in-valve (ViV) has emerged as a less invasive alternative to redo open surgical mitral valve replacement in patients at high surgical risk and is usually performed using a transseptal route by femoral venous access. Rarely, this approach may not be feasible owing to venous occlusions or congenital inferior vena cava (IVC) interruption. CASE SUMMARY: A patient with agenesis of the femoral vein required a mitral ViV procedure, which was successfully done using transhepatic access. DISCUSSION: Agenesis of the femoral vein is a rare malformation. The transhepatic route can be an alternative for structural procedures in these patients, albeit with technical challenges and additional risks. TAKE-HOME MESSAGES: Transhepatic access is a feasible alternative for transcatheter, transseptal procedures in patients with IVC interruption; however, special care must be taken to guarantee proper access for hemostasis. Hemorrhagic complications remain a concern in patients who undergo mitral ViV procedures owing to the need for anticoagulation therapy.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.106122