Key result
A 26 mm SAPIEN valve was selected to fracture a previously implanted 23 mm Magna valve and over-expand a 23 mm SAPIEN valve in a 56-year-old man undergoing a valve-in-valve-in-valve procedure.
Case Report (n=1)
Demonstrates the feasibility of a transcatheter aortic valve-in-valve-in-valve procedure using a 26 mm SAPIEN valve to fracture a previously implanted 23 mm Magna surgical valve and over-expand a 23 mm SAPIEN valve.
A 56-year-old man underwent surgical aortic valve replacement (SAVR) with a 23 mm Magna Ease valve (Edwards Lifesciences) 10 years ago, followed by a 23 mm SAPIEN (Edwards Lifesciences) valve-in-valve transcatheter aortic valve implantation (TAVI) 9 years ago due to surgical valve endocarditis. During the SAPIEN implantation, a Vascular Plug III (Abbott) was placed in the left coronary cusp outside the surgical suture ring to occlude a paravalvular leak, leaving a residual mild leak (Panels A and B). Despite restenosis of the SAPIEN valve, the patient rejected redo open-heart surgery. Pre-SAVR computed tomography (CT) had revealed a native annulus of 24.3 mm (Panel D), whereas current CT illustrated an indexed annulus of 20.0 mm with the SAPIEN valve (Panel E). Coronary obstruction risk was deemed low due to a high coronary ostium (Panel C). Considering the 23 mm Magna has a 22 mm stent inner diameter (ID) and a 21 mm true ID, the heart team opted for a 26 mm SAPIEN valve to fracture the Magna valve and over-expand the SAPIEN valve.
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Mi et al. (2025) conducted a case report in Restenosis of transcatheter aortic valve (n=1). 26 mm SAPIEN valve implantation (valve-in-valve-in-valve) was evaluated. A 26 mm SAPIEN valve was selected to fracture a previously implanted 23 mm Magna valve and over-expand a 23 mm SAPIEN valve in a 56-year-old man undergoing a valve-in-valve-in-valve procedure.
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