title: Transcatheter Valve-in-Valve: A Cautionary Tale.
abstract: Transcatheter aortic valve replacement (TAVR) by valve-in-valve (VIV) implantation is an alternative treatment for high-risk patients with a degenerating aortic bioprosthesis. We present a case of transapical TAVR VIV with a 29-mm Edwards SAPIEN XT (ESV) (Edwards Lifesciences, Irvine, CA) into a 29-mm Medtronic Freestyle stentless bioprosthesis (Medtronic Inc, Minneapolis, MN) in which unanticipated dilatation of the Freestyle bioprosthesis resulted in intraprocedural embolization of the TAVR valve, necessitating urgent conversion to a conventional surgical aortic valve replacement (AVR). Our experience suggests that TAVR VIV with the 29-mm ESV in the setting of a degenerated 29-mm Freestyle stentless bioprosthesis must be undertaken with caution.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada.
authors.forename: Jessica G Y
authors.initials: JGY
authors.lastname: Luc
authors.affiliation: Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Miriam
authors.initials: M
authors.lastname: Shanks
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; CK Hui Heart Centre, Edmonton, Alberta, Canada.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Tyrrell
authors.affiliation: Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Welsh
authors.affiliation: Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Butler
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada. Electronic address: srmeyer@ualberta.ca.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meyer
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001705:Bioprosthesis; D001026:Coronary Artery Bypass / Q000379:methods; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D017548:Echocardiography, Transesophageal / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D018570:Risk Assessment; D012720:Severity of Illness Index; D013908:Thoracotomy / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome