Transapical and transfemoral combined mitral valve repair with annular and leaflet therapies.

Two high-risk patients have been successfully treated with concomitant implantation of a transapical off-pump beating heart semi-rigid D-shape annuloplasty device combined in one case with transfemoral edge-to-edge device and in another with transapical chordal implantation. The significant anteroposterior diameter reduction offered by the annuloplasty implantation maximized the leaflet coaptation obtained by the prolapse correction performed with the leaflet devices.