Small Degenerated Surgical Bioprosthetic Valve should be Treated with Supra-Annular Valve-in-Valve Transcatheter Aortic Valve Replacement

A B S T R A C T

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.

Keywords

Valve-in-valve, aortic stenosis, patient-prosthesis mismatch



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Article Info

Article Type
Case Report
Publication history
Received: Fri 24, Sep 2021
Accepted: Sat 09, Oct 2021
Published: Thu 09, Dec 2021
Copyright
© 2021 Ivica Kristic. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.JICOA.2021.04.02

Author Info

Corresponding Author
Ivica Kristic
Department of Cardiology, University Hospital of Split, Split, Croatia

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