Two birds with one stone: transcatheter valve-in-valve treatment of a failed surgical bioprosthesis with concomitant severe stenosis and paravalvular leak

• Published in: Clinical research in cardiology Vol. 108; no. 10; pp. 1069 - 1073
• Main Authors: Alvarez-Covarrubias, Hector A., Xhepa, Erion, Michel, Jonathan M., Kasel, A. Markus
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2019; Springer Nature B.V
• Subjects: Aged, 80 and over; Anticoagulants; Aortic stenosis; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Insufficiency - diagnosis; Aortic Valve Insufficiency - etiology; Aortic Valve Insufficiency - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - surgery; Balloon treatment; Bioprosthesis - adverse effects; Cardiology; Complications; Conflicts of interest; Contraindications; Critical Perspective; Echocardiography; Geriatrics; Heart valves; Humans; Implantation; Male; Medicine; Medicine & Public Health; Older people; Orifices; Ostomy; Patients; Prostheses; Prosthesis Design; Prosthesis Failure; Regurgitation; Reoperation; Risk groups; Sewing; Stenosis; Surgical implants; Transcatheter Aortic Valve Replacement - methods; Cracking; Valve-in-valve; Paravalvular leak; TAVR; Fracturing; TAVI
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-019-01519-6

Implantation of bioprosthetic surgical valves has been a common procedure in elderly patients with severe aortic stenosis due to patients´ preferences avoiding anticoagulation therapy. However, this valve presents sometime certain deterioration degree (i.e., dysfunction due to stenosis or regurgitation) or even paravalvular leak. Transcatheter heart valve implantation is a good alternative in high-risk patients. The valve-in-valve procedure has been shown to be a safe and effective procedure. However, the presence of the fixed sewing ring of the surgical bioprosthesis can hamper appropriate expansion of the THV. For this reason, the use of cracking balloon seems to be a safe alternative to increase the effective orifice area. We present a case of a patient with a degenerated previous implanted biological valve and paravalvular leak. We used the treatment strategy of valve-in-valve with post-dilatation with high-pressure balloon, in a way to treat both, the degenerated valve and the paravalvular leak. The use of a single percutaneous procedure was enough and safe to treat both problems without further complications. Graphic abstract