Failed valve-in-valve transcatheter aortic valve implantation.

c 2 a k o f d t 0 In 2004, a 68-year-old man received aortocoronary bypass surgery and a 23-mm Hancock porcine bioprosthesis (Medtronic, Minneapolis, Minnesota). Six years later, in January 2011, cardiac re-evaluation was performed due to progressive dyspnea. Invasive angiography showed open bypass grafts and severe stenosis of the porcine aortic bioprosthesis. Due to significant comorbidities, a 23-mm Sapien XT (Edwards Lifesciences, Irvine, California) transcatheter aortic valve (TAVI) was implanted as valve-in-valve. The procedure was uneventful. Initial angiography and echocardiography showed a good function of the valve with no insufficiency and a mean gradient of 20 mm Hg (Online Video 1). In March 2011, 3 months after the procedure, the patient was readmitted with cardiac decompensation. Reangiography showed open bypass grafts, but an invasive gradient of 50 mm Hg over the Sapien valve. Echocardiography confirmed the severe stenosis of the Sapien valve with a maximum gradient of 66 mm Hg, a mean of 43 mm Hg, and a valve opening area of 0.6 cm. Due to the severe dyspnea, reoperation was cheduled after recompensation. In May 2011, oth the Sapien valve and the 2004 implanted ancock bioprosthesis was explanted (Fig. 1) nd replaced with a 21-mm Trifecta (St. Jude edical, Inc., St. Paul, Minnesota) bioprostheis. The post-operative course was uneventful. Post-explantation assessment of the valves howed the implanted 23-mm Sapien valve in-