title: Transcatheter Aortic Valve-in-Valve Replacement Instead of a 4th Sternotomy in a 21-Year-Old Woman with Aortic Homograft Failure.
abstract: Transcatheter aortic valve replacement (TAVR) is a well-established method for replacing native aortic valves; however, it was conceived for elderly patients with aortic valve stenosis, and the lack of data on long-term durability has led practitioners to restrict the use of TAVR to patients who have short life expectancies. Here, we describe the case of a 21-year-old woman who had undergone 3 previous open aortic valve replacements and who presented with symptoms of recurrent valvular failure. Transthoracic echocardiograms and computed tomographic angiograms revealed a degenerating aortic root homograft with substantial calcification, moderate-to-severe aortic valve stenosis, and severe aortic valve regurgitation. Open surgical valve replacement posed substantial risk to our patient, so we decided to perform valve-in-valve TAVR with use of the Edwards Sapien XT Transcatheter Heart Valve. The patient's pulmonary artery pressure, valvular regurgitation, and symptoms improved substantially thereafter. We found that valve-in-valve TAVR into a failing aortic root homograft was less invasive than repeat surgical valve replacement in this young patient who had congenital vascular anomalies and a complex surgical history.
authors.forename: José G
authors.initials: JG
authors.lastname: Díez
authors.forename: Michael
authors.initials: M
authors.lastname: Schechter
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dougherty
authors.forename: Ourania
authors.initials: O
authors.lastname: Preventza
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Coselli
mesh_terms: D064591:Allografts; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D063126:Balloon Valvuloplasty; D001705:Bioprosthesis; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D011475:Prosthesis Failure; D020127:Recovery of Function; D012086:Reoperation; D012720:Severity of Illness Index; D056346:Sternotomy; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aortic valve insufficiency/therapy; cardiac catheterization/instrumentation/methods; heart valve prosthesis implantation/methods; reoperation; risk factors; treatment outcome