What question did this study set out to answer?

This report aims to highlight complications during valve-in-valve TAVI procedures, particularly guidewire trajectory errors.

March 13, 2026Open Access

Intraoperative TEE Detection of Guidewire Malposition and Incomplete Valve Expansion in Valve-in-Valve TAVI for Trifecta Bioprosthesis Failure: a Case Report

Key Result

Intraoperative TEE identified guidewire malposition leading to incomplete expansion in ViV-TAVI, necessitating repositioning for optimal valve function.

Key Points

This report aims to highlight complications during valve-in-valve TAVI procedures, particularly guidewire trajectory errors.
Describes a case involving an 84-year-old woman with a failed Trifecta bioprosthesis
Utilized intraoperative transoesophageal echocardiography to assess valve deployment
Repositioned the guidewire based on TEE findings
Guidewire initially malpositioned between degenerated leaflets leading to incomplete expansion
Successful repositioning under TEE guidance allowed for full valve expansion
Achieved optimal haemodynamics following corrective measures

Structured PICO

Population

1 84-year-old woman with a failed 21-mm Trifecta bioprosthesis

Intervention

Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) with intraoperative transoesophageal echocardiography (TEE) guidance

Intraoperative TEE is crucial during ViV-TAVI for failed Trifecta bioprostheses to confirm central guidewire trajectory and prevent incomplete valve expansion.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Structured Abstract Background Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is widely used for failed surgical bioprostheses; however, procedural pitfalls remain, particularly in valves prone to early structural deterioration. Case summary An 84-year-old woman with a failed 21-mm Trifecta bioprosthesis underwent ViV-TAVI. Although the guidewire crossed smoothly and fluoroscopy appeared reassuring, incomplete valve expansion occurred. Intraoperative transoesophageal echocardiography revealed that the guidewire had passed between degenerated leaflets rather than through the true central orifice. After repositioning under TEE guidance, full symmetric valve expansion and optimal haemodynamics were achieved. Discussion This case highlights the risk of false procedural reassurance during ViV-TAVI and underscores the importance of actively confirming central guidewire trajectory, particularly in failed Trifecta bioprostheses.