Key result
Emergent TAV-in-TAV resolves severe aortic regurgitation and reverses cardiogenic shock in failing bioprosthesis.
Why the study?
Does an emergent transcatheter aortic valve-in-valve procedure reverse severe aortic regurgitation and cardiogenic shock in an unstable patient with acute bioprosthetic valve failure?
Case Report (n=1)
No
Does an emergent transcatheter aortic valve-in-valve procedure reverse severe aortic regurgitation and cardiogenic shock in an unstable patient with acute bioprosthetic valve failure?
Emergent TAV-in-TAV can serve as a successful, less-invasive life-saving intervention for high-surgical-risk patients presenting with cardiogenic shock due to acute bioprosthetic valve failure.
Supports feasibility of emergent TAV-in-TAV in acute bioprosthetic failure with shock; hypothesis-generating and requires prospective validation.
BACKGROUND: We present an 82-year-old man with a history of coronary artery disease status after coronary artery bypass grafting, percutaneous coronary intervention, hypertension, and severe aortic stenosis status post transcatheter aortic valve replacement who presented to the emergency department with substernal chest pain and dyspnea. CASE SUMMARY: and chest x-ray suggestive of pulmonary edema. He became hypotensive and was started on pressor support. Left heart catheterization showed a stable coronary artery anatomy but severe aortic regurgitation through a failing Evolut valve (Medtronic). Because of hemodynamic instability, we proceeded with an emergent transcatheter aortic valve-in-valve procedure with a new valve, which resolved his aortic regurgitation. DISCUSSION: Transcatheter aortic valve replacement is typically performed to treat aortic stenosis or regurgitation in stable patients, but in this case it was used to mitigate a patient's severe aortic regurgitation through a prior bioprosthetic valve because of his hemodynamic instability. TAKE-HOME MESSAGE: This case highlights the use of an emergent transcatheter aortic valve-in-valve bioprosthetic valve replacement to treat a patient with cardiogenic shock secondary to severe aortic insufficiency.
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Wells et al. (2026) conducted a case report in Severe aortic regurgitation and cardiogenic shock due to bioprosthetic valve failure (n=1). Emergent transcatheter aortic valve-in-valve (TAV-in-TAV) replacement was evaluated on Resolution of aortic insufficiency and hemodynamic instability. Emergent transcatheter valve-in-valve replacement successfully resolved severe aortic insufficiency and reversed cardiogenic shock in a patient with a failing bioprosthetic valve.
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