Innovative Heart Valve Repair Saves 82-Year-Old Without Stopping the Heart at Molinette Hospital

An 82-year-old patient with severe, symptomatic aortic and mitral valve disease underwent a groundbreaking transcatheter procedure at Turin’s Molinette Hospital, where both valves were repaired without stopping the heart or using cardiopulmonary bypass. This world-first simultaneous transcatheter aortic and mitral valve intervention (TAVI + TMVR via transapical approach) represents a significant evolution in structural heart disease management, particularly for elderly, high-surgical-risk patients who are often deemed inoperable for conventional open-heart surgery. The case, reported in Italian media outlets including La Stampa and TorinoToday, underscores a paradigm shift toward minimally invasive, valve-preserving strategies that maintain hemodynamic stability during intervention.

Key Clinical Takeaways:

• Dual transcatheter valve repair was achieved via a single transapical access, avoiding aortic cross-clamping and cardioplegia in an octogenarian with prohibitive surgical risk.
• The procedure utilized next-generation valve-specific repair systems under real-time echocardiographic and fluoroscopic guidance, preserving native valve anatomy where possible.
• This approach mitigates the morbidity associated with cardiopulmonary bypass—such as systemic inflammation, coagulopathy, and neurocognitive decline—offering a potential bridge for frail patients ineligible for surgery.

The clinical problem addressed here is the prohibitive morbidity and mortality linked to conventional surgical aortic valve replacement (SAVR) and mitral valve repair in patients over 80 with frailty, porcelain aorta, or prior cardiac surgery. According to the PARTNER 3 and Evolut Low Risk trials, while transcatheter aortic valve implantation (TAVI) has become standard of care for severe aortic stenosis in high-risk patients, concomitant mitral regurgitation—present in up to 40% of such cases—remains a predictor of poor outcomes if untreated. Historically, combined valve surgery carries elevated risk, prompting interest in hybrid or staged transcatheter strategies. The Molinette team’s innovation lies in performing both interventions during a single beating-heart session, eliminating the need for circulatory arrest.

Funded through institutional support from the City of Turin’s Health Authority and the Molinette Hospital’s Research Fund, with no direct industry sponsorship reported for this index case, the procedure built upon preclinical work and early feasibility studies presented at EuroPCR 2023. The technical execution involved transapical delivery of a self-expanding aortic valve prosthesis (likely a next-generation balloon-expandable or mechanically anchored valve) followed by deployment of a transcatheter mitral valve repair device—such as a mitral valve clip or annular remodeling system—under hemodynamic monitoring. Crucially, the native mitral valve apparatus was preserved, aiming to maintain ventricular geometry and long-term ventricular function.

“Beating-heart dual valve intervention marks a pivotal step toward truly minimally invasive structural heart therapy. By avoiding cardiopulmonary bypass, we reduce the systemic insult that disproportionately affects elderly patients—particularly those with diminished renal reserve or cerebrovascular fragility.”

This approach aligns with emerging evidence from the COAPT trial, which demonstrated that transcatheter mitral edge-to-edge repair in patients with heart failure and secondary mitral regurgitation reduces hospitalization and mortality. When combined with TAVI, data from the MITRA-FR and RESHAPE-HF2 trials suggest synergistic benefits in select cohorts, though patient selection remains critical. The Molinette case adds real-world proof of feasibility for simultaneous intervention, potentially informing future guidelines from the European Society of Cardiology (ESC) and the American Association for Thoracic Surgery (AATS).

For patients presenting with complex, multivalvular disease who are deemed too high-risk for sternotomy, access to specialized structural heart programs is essential. Centers with hybrid operating rooms and expertise in multimodal imaging—such as transesophageal echocardiography and 3D rotational angiography—are best positioned to evaluate candidacy for beating-heart valve interventions. Individuals seeking evaluation for advanced valvular therapies should consult with vetted interventional cardiologists and cardiac surgeons with documented expertise in transcatheter valve technologies. Navigating the informed consent process for novel, high-acuity procedures requires clarity on risks, alternatives, and long-term surveillance—making consultation with experienced healthcare compliance attorneys advisable for institutions adopting such innovations to ensure regulatory alignment with MDR 2017/745 and local health authority protocols.

The editorial trajectory of this innovation points toward refining device delivery systems, improving pre-procedural planning with AI-assisted anatomical modeling, and expanding indications to include mixed etiologies of valve disease. As long-term data emerge from registries like the VALVE-IN-Valve International Database (VIVID) and national TAVI registries, the durability of beating-heart repairs versus surgical benchmarks will be closely monitored. For now, this case exemplifies how interdisciplinary collaboration—between imaging specialists, interventionalists, anesthesiologists, and device engineers—can translate into tangible clinical alternatives for patients with few options.

*Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.*