One-stage off-pump transapical repair of ventricular pseudoaneurysm with coils and mitral paravalvular leak closure with plugs

We present the case of a 74-year-old male with a medical history of hypertension, type 2 diabetes, and dyslipidemia, who had previously undergone two cardiac surgeries: the first for coronary artery disease and severe mitral regurgitation, and the second for mitro-aortic endocarditis. The patient developed a large inferolateral ventricular pseudoaneurysm, an anterolateral mitral paravalvular leak with moderate mitral regurgitation, and a complete atrioventricular block. Given the high risk associated with a third conventional open-heart surgery, a hybrid off-pump transapical approach was proposed. The patient was successfully treated with coil closure of the pseudoaneurysm, repair of the paravalvular leak using an Amplatzer device, and implantation of definitive epicardial electrodes via a transapical approach, with complete procedural success.