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With an 8.5% score in the Society of Thoracic Surgeons risk score for mortality rate, we decided to implant one Evolut PRO transfemoral bioprostheis on an underexpanded bioprosthesis. The computed tomography confirmed the lack of coverage of the bioprosthetic stent over the aortic annulus at the level of the Valsava, non-coronary and right coronary sinuses (figure 1), indicative of stent recoil of the stent harboring the bioprosthetic leaflets as the possible mechanism of periprosthetic failure and causing malapposition with the aortic annulus. The perimeter of the aortic annulus was 79.3 mm (minimum diameter: 22 mm; maximum diameter: 25 mm).

Evolut R implantation in Perceval bioprosthesis with periprosthetic leakage. Case resolution