Degeneration of bioprosthesis may occur in elderly and frail patients with an extremely high risk for redo cardiac surgery. Transcatheter
valve-in-valve procedures represent a valuable treatment option in high-risk patients [1,2]. However incidental findings may contraindicate the
transcatheter procedure. We describe the original case of a patient who was scheduled for transapical mitral valve-in-valve, but due to a left a
trial mass underwent mini-invasive surgery with successful direct mitral valve-in-valve delivery and excision of the mass.
Keywords: TAVI; Transcatheter; Mitral; Valve-in-valve; Bioprosthesis failure; Minimally invasive surgery