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Valve‐in‐valve‐in‐valve: Balloon expandable transcatheter heart valve in failing self‐expandable transcatheter heart valve in deteriorated surgical bioprosthesis
Author(s) -
Schaefer Andreas,
Deuschl Florian,
Conradi Lenard,
Schäfer Ulrich
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27797
Subject(s) - medicine , hemodynamics , heart valve , stent , balloon , surgery , cardiology , valve replacement , aortic valve , stenosis
Valve‐in‐valve (ViV) procedures for failing bioprostheses carry a certain risk for device malfunction. We herein report a case of a failing Evolut R in a deteriorated Mitroflow, treated with a Sapien 3. An 81 year old female patient received surgical aortic valve replacement and was treated by ViV due to deterioration. Three years later, echocardiography revealed a pressure gradient of peak/mean 105/63 mmHg. Subsequently, a second ViV procedure with initial intentional rupture of the bioprosthetic stent was performed. Immediate stent recoil of the Evolut R prompted implantation of a Sapien 3. In 30‐day follow‐up, mean pressure gradient of 30 mmHg and nearly complete symptom relief was documented. Fracture of a surgical bioprosthetic stent is feasible in a ViV configuration. Supra‐annular placement of a balloon‐expandable THV as ViV‐in‐valve is feasible with suboptimal hemodynamic results in this case. Risk of re‐do surgery should be weighted against anticipated hemodynamic and clinical results.