Direct transatrial transcatheter mitral valve-in-valve implantation: an alternative access for an aborted transapical procedure

We report a case of a 77-year-old female who underwent a mitral valve replacement 20 years earlier and now presented with progressive dyspnoea and a degenerated Mosaic mitral valve bioprosthesis. We performed a transapical transcatheter mitral valve-in-valve implantation, which was complicated by a myocardial tear at the apex due to frail tissue and the procedure was aborted. After recovery of this event, we decided to perform a hybrid procedure, which was a direct transatrial transcatheter mitral valve-in-valve implantation through a right mini thoracotomy. This procedure went uncomplicated and further recovery went uncomplicated.