Valve-in-Valve Transcatheter Aortic Valve Replacement in a High-Risk Patient with a Biocor Bioprosthesis and a Flail Prosthetic Valve Leaflet

An 80-year-old woman with a history of surgical aortic valve replacement 21 mm St. Jude Medical Biocor porcine 14 years prior presented New York Heart Association (NYHA) class III symptoms, severe insufficiency from degenerated prosthesis, and large echocardiographic mobile mass representing highly prosthetic leaflet. The patient worsened to NYHA IV symptoms despite medical management. Society Thoracic Surgery mortality risk score was extremely high. However, valve-in-valve transcatheter (TAVR) found be reasonable option. We used 20 SAPIEN 3 Ultra (Edwards Lifesciences Inc., Irvine, CA, USA) SENTINEL embolic protection device (Boston Scientific, Marlborough, MA, USA). During deployment, the visually pinned between new TAVR bioprosthetic valve. No debris noted within device, remained without any focal neurologic deficits in perioperative period at 30-day follow-up. resolved, clinically improved II symptoms.