Pannus formation after transcatheter aortic valve implantation resulting in prosthetic valve dysfunction: a case report

Background Subaortic pannus formation (SAP) is a recognized complication following surgical aortic valve replacement (SAVR), typically manifesting around 5 years post-implantation. However, SAP occurrence after transcatheter aortic valve implantation (TAVI) remains poorly documented and investigated. Case summary This case report presents a 79-year-old male who presented to our clinic with fatigue on exertion after having undergone TAVI with a 26-mm Edwards SAPIEN 3 valve 3 years prior to presentation. Echocardiography revealed elevated transprosthetic gradients, with no improvement after initiation of anticoagulation therapy. On cardiac tomography imaging, SAP was suspected. The patient underwent successful reoperative SAVR with concomitant mitral and tricuspid valve repair. Intraoperatively, severe pannus formation with subvalvular obstruction of the valve opening area was observed. Discussion This case highlights the risk of early SAP formation following TAVI, underscoring the need for long-term follow-up and a more thorough understanding of the underlying pathophysiology.