Key result
Transcatheter aortic valve-in-valve-in-valve implantation using 3D printing and fusion imaging guidance was successfully performed, with the patient remaining asymptomatic at 5-year follow-up.
Why the study?
Valve-in-valve implantation is a valid option for bioprosthetic valve failure, but experience with transfemoral valve-in-valve-in-valve TAVR guided by 3D printing and fusion imaging had not been described.
Case Report (n=1)
Transcatheter aortic valve-in-valve-in-valve implantation is feasible and can provide durable clinical benefit up to 5 years when supported by advanced pre- and intraprocedural imaging guidance.
BACKGROUND: Valve-in-valve implantation (ViV) has become a valid option for the treatment of bioprosthetic valve failure. We describe the first in-man transfemoral transcatheter aortic valve replacement (TAVR) or "turducken" in a patient with previous TAVR within surgical aortic valve replacement with preprocedural guidance utilizing three-dimensional (3D) printing and intraprocedural guidance with fusion imaging. CASE SUMMARY: A 65-year-old male with a previous valve-in-valve with a transcatheter Melody valve presented with symptomatic severe valvular and paravalvular aortic incompetence. Using 3D printing for preprocedural guidance and computed tomography angiography-fluoroscopy fusion imaging for intraprocedural guidance we successfully placed a 29 mm self-expanding valve with minimal residual gradients. The patient continued to be asymptomatic at 1- and 5-year follow-up. DISCUSSION: We describe the first in man aortic valve-in-valve-in-valve using preprocedural guidance with 3D printing and intraprocedural guidance with fusion imaging. The valve has continued to demonstrate good function up to 5 years postprocedure suggesting that transcatheter aortic valve-in-valve-in-valve may be feasible with the proper pre- and intraprocedural guidance.
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Basman et al. (2020) conducted a case report in Symptomatic severe valvular and paravalvular aortic incompetence (n=1). Transcatheter aortic valve-in-valve-in-valve implantation with 3D printing and fusion imaging guidance was evaluated on Procedural success and clinical symptoms. Transcatheter aortic valve-in-valve-in-valve implantation using 3D printing and fusion imaging guidance was successfully performed, with the patient remaining asymptomatic at 5-year follow-up.
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