TENDYNE mitral valve implantation complicated by heparin-induced thrombocytopenia in a patient with NSCLC: a case report

Background Transcatheter mitral valve replacement (TMVR) is an emerging therapeutic option [SA1.1] for patients with complex mitral valve disease who are at high surgical risk. The TENDYNE transcatheter mitral valve system enables treatment in anatomically challenging cases but may be associated with early device thrombosis prior to endothelialization. We report a complex cardio-oncology case of a 52-year-old man with severe combined mitral valve disease and concomitant potentially curable non-small cell lung cancer who underwent TMVR following induction chemo-immunotherapy to optimize oncologic timing.Case summary The early postoperative course was complicated by heparin-induced thrombocytopenia (HIT) type II, resulting in progressive thrombosis of the left atrium and prosthetic valve despite therapeutic anticoagulation with argatroban. Imaging demonstrated significant prosthetic obstruction requiring urgent surgical thrombectomy, explantation of the transcatheter valve, and bioprosthetic mitral valve replacement. After multidisciplinary perioperative management, including tailored anticoagulation strategies, the patient recovered and was discharged in stable condition.Discussion This case highlights the interplay between TMVR-associated thrombogenicity, HIT-driven hypercoagulability, and the complexity of treatment sequencing in cardio-oncology patients, emphasizing the importance of individualized, interdisciplinary decision-making.