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January 1, 2021Ochsner JournalOpen Access

Balloon Expandable Transcatheter Aortic Valve Implantation in Failing Self-Expandable Transcatheter Valve in Degenerated Surgical Bioprosthesis: Valve-in-Valve-in-Valve Implantation for the Treatment of Early Degenerative Prosthetic Insufficiency

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Why the study?

Transcatheter aortic valves can degenerate, prompting the need to report outcomes of redo TAVI such as valve-in-valve-in-valve implantation for early prosthetic insufficiency.

Population

One 70-year-old male with decompensated heart failure from severe prosthetic valve insufficiency

Comparison

29-mm SAPIEN 3 valve-in-valve-in-valve implantation

Design

Case report

Key result

Early bioprosthetic valve insufficiency after initial valve-in-valve implantation was successfully treated with a second TAVI, resulting in improved ejection fraction and no regurgitation at 30 days.

Authors

ASAhmed SubahiRARashid AlhusainRARasikh Ajmal

Discussion

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Overview

May support valve-in-valve-in-valve feasibility in select cases; hypothesis-generating and should not yet change practice.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P
Population
A 70-year-old male with decompensated heart failure secondary to severe prosthetic valve insufficiency who underwent a third valve implantation (valve-in-valve-in-valve) and was followed for 30 days.
I
Intervention
Transcatheter aortic valve implantation with a 29-mm SAPIEN 3 valve (valve-in-valve-in-valve procedure).
O
Outcome
Clinical and echocardiographic results, and coronary obstruction.

Early bioprosthetic valve insufficiency after initial valve-in-valve implantation can be successfully treated with a second TAVI (valve-in-valve-in-valve).

Limitations

  • Long-term durability of ViV second or third TAVI for degenerated transcatheter bioprosthesis is unknown.
  • Paucity of data regarding feasibility, short-term outcomes, and long-term outcomes of double transcatheter ViV implantation.
  • No published data are available on valve selection or sizing for TAVI inside an existing TAVI prosthesis.

Cite This Study

Subahi et al. (2021) conducted a case report in Severe prosthetic valve insufficiency (n=1). Valve-in-valve-in-valve TAVI (SAPIEN 3 valve) was evaluated on Clinical and echocardiographic improvement. Early bioprosthetic valve insufficiency after initial valve-in-valve implantation was successfully treated with a second TAVI, resulting in improved ejection fraction and no regurgitation at 30 days.

synapsesocial.com/papers/6aa2f9880fc92d3596e57386https://doi.org/10.31486/toj.20.0011
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery2010 · 7,230 citations
  2. 2ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease2006 · 8,515 citations
  3. 3Transcatheter Aortic Valve Implantation Within Degenerated Aortic Surgical Bioprostheses2017 · 325 citations
  4. 4Valve-in-Valve TAVR: State-of-the-Art Review2019 · 67 citations
  5. 5Long-term Transcatheter Aortic Valve Durability2019 · 38 citations