Self-expandable valve-in-valve transcatheter aortic valve implantation for a failed sutureless Perceval bioprosthesis: a case report

Background Early structural degeneration of sutureless Perceval bioprostheses is uncommon but may result in severe hemodynamic compromise and heart failure. Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) represents a less invasive therapeutic option in high-risk patients. [1,2] Case summary A 78-year-old woman presented with progressive dyspnea and lower-extremity edema three years after surgical aortic valve replacement with a Perceval bioprosthesis. Transthoracic echocardiography revealed severe mixed prosthetic valve dysfunction with markedly elevated transvalvular gradients. Owing to prohibitive surgical risk, comprehensive preprocedural planning with echocardiography and multidetector computed tomography was performed to assess annular dimensions and coronary anatomy. A self-expandable valve-in-valve TAVI was successfully performed, guided by fluoroscopic visualization of the Perceval inflow ring. Discussion This case highlights the importance of understanding sutureless valve geometry and meticulous CT-based planning when performing ViV-TAVI with a self-expandable transcatheter valve. [4] Take Home Messages Self-expandable ViV-TAVI is a feasible and effective treatment option for failed Perceval valves when guided by careful anatomical assessment.