What if Valve-in-Valve TAVR fails? Is surgical re-replacement still an option in high-risk patients? A case report.

Luca De Donno; Alan Galligani; Francesco  Maestri; Florida Gripshi; Claudia Pattuzzi; Matteo Scarpanti; Elena Adelina Gabor; Arianna Manca; Francesco  Nicolini

doi:10.23750/abm.v93iS1.11705

What if Valve-in-Valve TAVR fails? Is surgical re-replacement still an option in high-risk patients? A case report.

Authors

Luca De Donno a:1:{s:5:"en_US";s:55:"Departement of Cardiac Suurgery, Parma General Hospital";}
Alan Galligani Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, Parma, Italy.
Francesco Maestri Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, Parma, Italy.
Florida Gripshi Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, University of Parma, Parma, Italy
Claudia Pattuzzi Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, University of Parma, Parma, Italy
Matteo Scarpanti Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, University of Parma, Parma, Italy
Elena Adelina Gabor Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, University of Parma, Parma, Italy
Arianna Manca Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, University of Parma, Parma, Italy
Francesco Nicolini Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital “Azienda Ospedaliera-Universiteria” of Parma, University of Parma, Parma, Italy

Keywords:

Redo aortic surgery, transcatheter aortic valve replacement, surgical aortic valve replacement, valve dislocation.

Abstract

Redo surgical aortic valve replacement has been the gold standard for the treatment of degenerated bioprostheses; however it carries an inherent risk associated with a reoperative open heart surgery. Valve-in-Valve transcatheter aortic valve implantation (ViV-TAVI) has emerged as an alternative approach. Few articles in literature review transcatheter aortic valve replacement’s failure rates, complications (i.e., valve dislocation, paravalvular leaks) and their surgical management. The rate of reoperations after a percutaneous approach is expected to increase, with the currently rising number of transcatheter procedures worldwide even in patients with a longer life expectancy. Valve dislocation is a rare but serious complication that can severely impact on the outcome of patients. Paravalvular leaks and structural valve degeneration are the most common causes of surgical re-intervention. We present the case of a complex patient with previous surgical aortic valve and ascending aorta replacement who underwent a transfemoral valve-in-valve TAVI for bioprosthesis degeneration, complicated by valve dislocation requiring surgical reoperation.

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