TY - JOUR
AR - JICOA-2021-4-102
TI - Small Degenerated Surgical Bioprosthetic Valve should be Treated with Supra-Annular Valve-in-Valve Transcatheter Aortic Valve Replacement
AU - Frane, Runjic
AU - Andrija, Matetic
AU - Matjaz, Bunc
AU - Nikola, Crncevic
AU - Ivica, Kristic
JO - Journal of Integrative Cardiology Open Access
PY - 2021
DA - Thu 09, Dec 2021
SN - 2674-2489
DO - http://dx.doi.org/10.31487/j.JICOA.2021.04.02 
UR - https://www.sciencerepository.org/small-degenerated-surgical-bioprosthetic_JICOA-2021-4-102 
KW - Valve-in-valve, aortic stenosis, patient-prosthesis mismatch
AB - Background: Patient-prothesis mismatch (PPM) is a serious potential complication following surgical aortic valve replacement (SAVR). If it develops, valve-in-valve transcatheter aortic valve replacement (TAVR) is a reasonable therapeutic option. However, there is low evidence on the management of small degenerated surgical bioprosthetic valves, not prone to balloon-valve fracture (BVF).
Case Presentation: This case report presents a successful valve-in-valve TAVR in acute heart failure due to degenerative surgical bioprosthetic valve Trifecta (21 mm) that is not susceptible to BVF. Standard preparation for transfemoral TAVR with a self-expandable valve was conducted, including the over-the-wire pacing. Thereafter, a successful valve-in-valve primary implantation of the self-expanding, supra-annular valve Evolut R 26 (Medtronic™) has been achieved. Follow-up at 3 months showed mild paravalvular leak in the region with clinical and heart function improvements of the patient. Follow-up echocardiographic parameters showed the reduction of anterograde flow impairment and improved effective orifice area (~0.85 cm2/m2).
Conclusion: In conclusion, supra-annular valve-in-valve TAVR is a potential therapeutic option for PPM of small degenerated surgical bioprosthetic valves which are not prone to BVF.