VALVE-IN-VALVE IMPLANTATION GONE SOUTH: A CASE REPORT

Abstract

Valve-in-Valve (ViV) procedures for failed surgical bioprostheses are becoming increasingly common. We present a case of a 73-year-old male patient with significant comorbidities who underwent a primary transcatheter aortic valve implantation (TAVI) with an Evolut 29 mm (Medtronic, Minneapolis, MN, USA) valve. This TAVI-prosthesis implantation failed due to the inability to fix the valve at the appropriate height to achieve an optimal hemodynamic result. The valve had to be snared and pulled into an adequate position and was then fixed by an implantation of another TAVI-prosthesis (29 mm Sapien S3, Edwards Lifesciences, Irvine, CA, USA) with optimal final result. The patient was discharged after significant clinical improvement and without further complications.

Keywords: complications; structural interventions; transcatheter aortic valve replacement.

Figure 1

Preprocedural AR (Perimount 27 mm)

Figure 2

Positioning of the Evolut 29mm prosthesis in degenerated aortic bioprosthetic valve.

Figure 3

Migration of the Evolut 29 mm prosthesis into the left ventricle and severe AR.

Figure 4

Simultaneous Sapien S3 29 mm TAVI-implantation and pulling of the Evolut prosthesis in the direction of the aorta by double snare engagement using Agilis sheaths.

Figure 5

Optimal position of both TAVI prostheses and absence of AR.