title: Surgical aortic valve replacement after percutaneous aortic valve implantation: what have we learned?
abstract: OBJECTIVE
  We report the first case description of surgical aortic valve replacement after percutaneous valve implantation.
  
  
  METHODS
  An 87-year-old man with severe aortic stenosis who was rejected for surgical intervention underwent percutaneous valve implantation through a retrograde femoral approach. The procedure was complicated by cardiogenic shock caused by severe aortic insufficiency, leading to emergency surgical aortic valve replacement.
  
  
  RESULTS
  The operative findings revealed the presence of commissural paravalvular leaks and centrally malapposed leaflets. Surgical replacement was uneventful, and the patient was discharged on day 30, despite a challenging postoperative course. His follow-up at 1 year has been uneventful. This case illustrates that overdilatation of the stent is not recommended because it might worsen central aortic insufficiency. Moreover, the transapical route should be considered when the appropriately sized prosthesis is unable to be inserted because of inappropriate vascular access. However, despite an initial "prohibitive" surgical risk, surgical aortic valvular replacement after percutaneous valve implantation could be easily performed.
  
  
  CONCLUSIONS
  Percutaneous heart valve implantation, which provides a larger surface area than balloon valvotomy, can be offered to patients with cardiogenic shock and severe comorbidities to improve their hemodynamic state and reduce their surgical risk.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital Charles Nicolle, Rouen, France. pierre-yves.litzler@chu-rouen.fr
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Litzler
authors.forename: Alain
authors.initials: A
authors.lastname: Cribier
authors.forename: Alan
authors.initials: A
authors.lastname: Zajarias
authors.forename: Diane
authors.initials: D
authors.lastname: Comte
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
authors.forename: Christophe
authors.initials: C
authors.lastname: Tron
authors.forename: Catherine
authors.initials: C
authors.lastname: Haas-Hubscher
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Bessou
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D004630:Emergencies; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012086:Reoperation; D012770:Shock, Cardiogenic / Q000601:surgery; D015607:Stents / Q000009:adverse effects