Valve-in-Valve-in-Valve transcatheter aortic valve implantation; to treat a degenerated surgical bioprosthesis in a subaortic position

Rutger Jan Nuis, Luis M. Benitez, Carlos A. Nader, Sergio Perez, Eduardo J.Marchena de Marchena, Antonio E. Dager

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Transcatheter aortic valve implantation for aortic stenosis has evolved as an alternative treatment for patients who are at high or excessive surgical risk. We report the case of an 84-year-old man with a degenerated surgically implanted valve in a subaortic position (9 mm below the native annulus) who underwent "valve-in-valve" transcatheter aortic valve implantation with use of a Medtronic CoreValve system. We planned to deploy the Core-Valve at a conventional depth in the left ventricular outflow tract; we realized that this might result in paravalvular regurgitation, but it would also afford a "deep" landing site for a second valve, if necessary. Ultimately, we implanted a second CoreValve deep in the left ventricular outflow tract to seal a paravalvular leak. The frame of the first valve-positioned at the conventional depth-enabled secure anchoring of the second valve in a deeper position, which in turn effected successful treatment of the failing subaortic surgical prosthesis without paravalvular regurgitation.

Original languageEnglish (US)
Pages (from-to)323-325
Number of pages3
JournalTexas Heart Institute Journal
Volume40
Issue number3
StatePublished - Aug 12 2013

Keywords

  • Aortic valve insufficiency/surgery
  • Bioprosthesis
  • Heart valve prosthesis implantation/ instrumentation/methods
  • Intention-to-treat analysis
  • Reoperation/methods
  • Risk assessment
  • Treatment outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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