Lotus-in-Evolut R transcatheter aortic valve implantation for severe paravalvular leak

Significant paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) is associated with poor outcome. We present the case of an 83-year-old female with severe aortic stenosis who underwent TAVI with an Evolut-R valve (Medtronic, Minneapolis, MN, USA). An aortogram post-procedure showed aortic regurgitation thought to be moderately severe after post-dilatation. She deteriorated 24 h after her procedure and required a further intervention. She was salvaged with a Lotus (Boston Scientific, Marlborough, MA, USA) 'valve in valve' that completely eliminated PVL. <Learning objective: Significant paravalvular leak is a potential complication of transcatheter aortic valve implantation. This can result in poor outcomes especially in patients who have a small non-compliant left ventricular cavity with limited ability to compensate for volume overload. Such complications can be identified early by performing aortography, transthoracic echocardiogram and assessing invasive hemodynamics. A 'valve in valve' procedure with the Lotus valve (Boston Scientific, Marlborough, MA, USA) has shown favorable results in these patients.>.