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A 55-year-old man was referred to our institution for refractory heart failure. He first underwent mechanical aortic valve replacement (AVR) in 1975. In 2002 in the context of a type A aortic dissection he had redo AVR, consisting of an aortic homograft and stentless aortic root repair. Echocardiography showed severe aortic regurgitation in the absence of significant stenosis secondary to a degenerated aortic valve (Supplementary material online, Video S1). Computed tomography and transoesophageal echography confirmed the sealed type A aortic dissection (Figure 1). The patient was turned down from further surgical intervention due to the high risk of reoperation with a calcified degenerated homograft. Therefore, we planned percutaneous transcatheter aortic valve replacement (TAVR) using the self-expandable ACURATE NEO LARGE valve. Reaching the aortic valve was difficult due to the large aortic dissection (Supplementary material online, Video S2). However, an optimal final position was obtained for the TAVR (Supplementary material online, Video S3). Immediate improvement in haemodynamic parameters was observed. Echocardiography confirmed the result of the procedure (Supplementary material online, Video S4). The patient was discharged at Day 4. Discussion

Transcatheter aortic valve replacement using the ACURATE NEOTM valve to treat pure aortic regurgitation in a degenerated aortic homograft valve