Transcatheter Treatment of Balloon-Expandable Valve Structural Degeneration: A Single-Center Case Series

Background: Aside from the immediate intraprocedural transcatheter valve-in-valve implantation, there are only few case reports on TAV-in-TAV implantations. We report on a series of 4 patients with a degenerated Edwards Sapien XT who underwent transcatheter aortic valve implantation (TAV-in-TAV).

Methods: This is a retrospective analysis of prospectively collected data from our designated TAVI database. Intraprocedural and intrahospital outcomes are reported.

Results: The average time between initial implantation and re-intervention was 6.25 years. Three patients presented with severe stenosis and one patient with a combined stenosis and insufficiency. The mean preoperative maximum and mean gradient across the Sapien XT prosthesis were 60.8 ± 6.3 mm Hg and 35.8 ± 4.8 mm Hg, respectively. After uncomplicated transfemoral implantation of a Medtronic Evolut R prosthesis, the maximum and mean gradients decreased to 13.5 ± 2.3 mm Hg and 6.8 ± 1.3 mm Hg, respectively. The valve area increased from 0.84 ± 0.14 mm Hg to 1.89 ± 0.22 mm Hg. One patient experienced a vascular complication due to a dissection at the access site. Otherwise there were no VARC complications.

Conclusions: Our series shows, that a degenerated Edwards Sapien valve can efficiently be treated with a Medtronic Evolut R prosthesis, with significantly improved, single-digit mean gradients.