Early calcific degeneration of a CoreValve transcatheter aortic bioprosthesis

A 74-year-old man, one of the first few patients in the world to undergo transcatheter aortic valve implantation (TAVI) with the porcine CoreValve bioprosthesis presented with dyspnoea after 5 years. Echocardiogram and cardiac catheterization, respectively, revealed and confirmed bioprosthetic degenerative restenosis. The mean gradient across the CoreValve on transthoracic Doppler was 53 mmHg and pull-back gradient at catheterization was 79 mmHg. Aortic insufficiency was only mild. Of note, echocardiography 1 year earlier was unremarkable. In the absence of very high surgical risk, he underwent surgical bioprosthetic replacement. Extensive calcification of the explanted CoreValve's leaflets was noted both on the outflow and inflow surfaces. Although a rare event so early after CoreValve implantation, he was among the earliest patients. Appropriate patient selection and vigilance to determine long-term CoreValve durability is paramount, particularly with the interest in extending TAVI to lower-risk patients. Figure: Degenerated CoreValve. Panel (A) shows the continuous wave Doppler tracing across the aortic bioprosthesis on transthoracic echocardiography with a mean gradient of 53 mmHg. Panel (B) demonstrates the aortic pull-back gradient of 79 mmHg during cardiac catheterization. Surgical extraction of the degenerated CoreValve prosthesis was performed (C). Panels (D) and (E) demonstrate the extensive calcification on the outflow and inflow aspects of the porcine leaflets, respectively.