Cardiogenic shock in a patient with combined severe aortic and mitral regurgitation treated by a totally percutaneous approach: a case report.

Background: Combined severe aortic regurgitation and severe mitral regurgitation is a condition associated with high mortality, where evidence, about proper management, is still scarce, especially in critical clinical conditions such as cardiogenic shock. Case summary: An 86-year-old female with severe aortic and mitral regurgitation was admitted due to acute pulmonary oedema, rapidly deteriorating in cardiogenic shock refractory to medical treatment. Haemodynamic stabilization was achieved only after implantation of an Impella CP, through a trans-femoral approach. Considering the prohibitive surgical risk, the mitral valve regurgitation was treated with a transcatheter edge-to-edge repair procedure, which allowed to successfully wean the patient from Impella. Subsequently, a transcatheter aortic valve implantation was performed. The patient's clinical status improved to such a level that a rehabilitation program was successfully implemented. Discussion: Our report shows that an entirely percutaneous approach, to manage a combined severe aortic and mitral regurgitation, complicated by cardiogenic shock, is feasible and effective.