title: Second valve implantation for the treatment of a malpositioned transcatheter aortic valve.
abstract: BACKGROUND
  Unfavorable immediate or delayed results after transcatheter aortic valve implantation (TAVI) may be a consequence of bioprosthesis malfunctioning, malpositioning, embolization, or degeneration. Deployment of a second valve within the first one implanted (TAVI-in-TAV) may be a potentially helpful therapeutic strategy.
  
  
  METHODS
  Six out of 412 patients undergoing TAVI had TAVI-in-TAV implantation for the treatment of a too high (n = 4) or too low position (n = 2) of the first implanted valve.
  
  
  RESULTS
  All TAVI-in-TAV procedures were successfully performed. The calculated valve area after second valve implantation was 1.6 ± 0.3 cm(2) with a mean gradient of 7.3 ± 2.2 mm Hg. Residual aortic regurgitation (AR) was mild in 5 patients and moderate in 1. At mid-term follow-up (30-724 days) neither the mean valve area (1.47 ± 0.31 cm(2)), the mean gradient (7.5 ± 3.6 mm Hg; 3.0-13.0 mm Hg) nor the degree of AR had changed significantly.
  
  
  CONCLUSIONS
  TAVI-in-TAV for correction of malpositioned or embolized valves is technically feasible and leads to favorable functional results during mid-term follow-up.
authors.affiliation: Department of Cardiology, Cardiovascular Center Bern, University Hospital Bern, Bern, Switzerland.
authors.forename: Ênio E
authors.initials: ÊE
authors.lastname: Guérios
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.forename: Lutz
authors.initials: L
authors.lastname: Büllesfeld
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Christoph
authors.initials: C
authors.lastname: Huber
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D016896:Treatment Outcome