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The matryoshka procedure.

Fabrizio Tomai1, Luca Weltert1, Giovanni de Persio1

  • 1Department of Cardiovascular Sciences, European Hospital, Rome, Italy.

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Summary
This summary is machine-generated.

This case study details a successful valve-in-valve transcatheter aortic valve implantation (ViV TAVI) in a patient with degenerated bioprosthetic aortic valves. The procedure effectively reduced aortic stenosis gradients, demonstrating ViV TAVI

Keywords:
aortic valve replacementtranscatheter aortic valve implantationvalve-in-valve procedure

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Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • A 73-year-old male with aortic stenosis and root aneurysm underwent a modified Bentall-DeBono procedure in 2015, involving a bioprosthetic stented conduit.
  • Five years post-procedure, early bioprosthesis degeneration and mitral disease progression necessitated reintervention.
  • A second surgery implanted a Medtronic Mosaic mitral valve and a sutureless Livanova Perceval aortic valve, placed within the prior bioprosthetic frame due to removal difficulties.

Observation:

  • The patient presented with degenerated surgical aortic and mitral valves requiring further intervention.
  • A valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) approach was chosen due to challenges in explanting the prior aortic prosthesis.
  • The procedure involved careful navigation to deploy a new valve within the existing Perceval frame.

Findings:

  • A 23-mm Edwards Sapien 3 valve was successfully deployed within the sutureless Perceval aortic valve using a valve-in-valve transcatheter aortic valve implantation (ViV TAVI) technique.
  • The procedure was performed via a right femoral artery approach.
  • Post-deployment, the peak-to-peak left ventricular aortic gradient significantly decreased from 51 mmHg to 16 mmHg.

Implications:

  • This case demonstrates the feasibility and effectiveness of ViV TAVI in managing degenerated bioprosthetic aortic valves, particularly in complex anatomies.
  • The successful gradient reduction highlights the potential of ViV TAVI to restore hemodynamic function in patients unsuitable for repeat conventional surgery.
  • This approach offers a less invasive option for managing structural valve deterioration after previous aortic valve replacement.