Valve-in-valve transcatheter aortic valve implantation in a patient with residual chronic type A aortic dissection

Transcatheter aortic valve implantation (TAVI) is a viable treatment of choice in patients with severe aortic stenosis across a wide spectrum of surgical risks (inoperable-high-moderate-low risk). Valve-in-valve (ViV) TAVI has emerged as a valid treatment option in patients with failed aortic bioprosthetic valves, especially in those with intermediate, high or prohibitive risk of surgery.ViV TAVI in patients with prior surgical bioprosthesis presents significant challenges, particularly in cases with stentless valves or radiolucent posts. Therefore, adequate pre-procedural planning is of utmost importance to its success. However, our case had multiple challenges that had to be overcome, including radiolucent posts, residual chronic type A aortic dissection flap in the non-coronary cusp and large body habitus with Killip class IV. Having successfully navigated the above challenges, we report this interesting and complex case of ViV TAVI which was a procedural success associated with significant improvement and recovery.