title: Valve-in-valve-in-valve transcatheter aortic valve implantation to treat a degenerated surgical bioprosthesis in a subaortic position.
abstract: Transcatheter aortic valve implantation for aortic stenosis has evolved as an alternative treatment for patients who are at high or excessive surgical risk. We report the case of an 84-year-old man with a degenerated surgically implanted valve in a subaortic position (9 mm below the native annulus) who underwent "valve-in-valve" transcatheter aortic valve implantation with use of a Medtronic CoreValve system. We planned to deploy the CoreValve at a conventional depth in the left ventricular outflow tract; we realized that this might result in paravalvular regurgitation, but it would also afford a "deep" landing site for a second valve, if necessary. Ultimately, we implanted a second CoreValve deep in the left ventricular outflow tract to seal a paravalvular leak. The frame of the first valve--positioned at the conventional depth--enabled secure anchoring of the second valve in a deeper position, which in turn effected successful treatment of the failing subaortic surgical prosthesis without paravalvular regurgitation.
authors.affiliation: Erasmus ThoraxCenter, 3015 CE, Rotterdam, The Netherlands. r.nuis@erasmusmc.nl
authors.forename: Rutger-Jan
authors.initials: RJ
authors.lastname: Nuis
authors.forename: Luis M
authors.initials: LM
authors.lastname: Benitez
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Nader
authors.forename: Sergio
authors.initials: S
authors.lastname: Perez
authors.forename: Eduardo J
authors.initials: EJ
authors.lastname: de Marchena
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Dager
mesh_terms: D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000295:instrumentation*; D017548:Echocardiography, Transesophageal; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015641:Radiography, Interventional; D016896:Treatment Outcome
keywords: Aortic valve insufficiency/surgery; bioprosthesis; heart valve prosthesis implantation/instrumentation/methods; intention-to-treat analysis; reoperation/methods; risk assessment; treatment outcome
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