title: Transcatheter aortic valve-in-valve-in-valve implantation for a failed xenograft.
abstract: A 78-year-old gentleman with a diagnosis of symptomatic severe xenograft aortic stenosis with multiple comorbidities was referred for transcatheter aortic valve implantation, that is, a "valve-in-valve" procedure. Transcatheter aortic valve implantation was performed by transapical approach using a balloon-expandable bioprosthesis. During valve deployment, the prosthesis moved toward the left ventricle and a second balloon-expandable valve was implanted within the first one-a "valve-in-valve-in-valve" to avoid further ventricular embolization of the first bioprosthesis. Echocardiography at hospital discharge showed a residual mean transvalvular gradient of 17 mm Hg and trivial paravalvular aortic regurgitation. At 1 year follow-up, the patient was in New York Heart Association functional class II.
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bagur
authors.forename: Éric
authors.initials: É
authors.lastname: Dumont
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.forename: Robert
authors.initials: R
authors.lastname: De Larochellière
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D001705:Bioprosthesis; D000075202:Contraindications; D023903:Coronary Restenosis / Q000628:therapy; D054855:Drug-Eluting Stents; D057510:Endovascular Procedures / Q000379:methods*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011474:Prosthesis Design; D015641:Radiography, Interventional; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D056346:Sternotomy; D014463:Ultrasonography
chemical_list: D000305:Adrenal Cortex Hormones