Sequential transcatheter aortic and pulmonic valve replacement in bioprosthetic valve dysfunction: a case report

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Cardiac Surgery

Background:

• Transcatheter valve replacement is a minimally invasive alternative to surgical valve replacement, increasingly favored for high-risk patients.
• Patients with multiple prior sternotomies and multi-valvular failure present unique challenges for traditional surgical interventions.
• Sequential transcatheter valve procedures may offer a viable solution for complex multi-valvular disease in high-risk populations.

Observation:

• A 61-year-old male with two prior sternotomies and symptomatic aortic and pulmonary stenosis underwent sequential transcatheter valve replacements.
• The patient was deemed high-risk for repeat sternotomy, necessitating an alternative approach.
• Procedures included valve-in-valve transcatheter aortic valve replacement (TAVR) followed by transcatheter pulmonic valve replacement (TPVR) one month apart.

Findings:

• The patient successfully underwent sequential TAVR and TPVR using Edwards Sapien 3 valves.
• Both procedures were well-tolerated, and the patient remained asymptomatic at one-month follow-up.
• This represents the first reported successful case of sequential TAVR and TPVR with right ventricular outflow tract stenting in a patient with combined aortic and pulmonic bioprosthetic valve dysfunction.

Implications:

• Transcatheter valve replacement can be a feasible and effective strategy for patients with multiple degenerated bioprosthetic valves and prior sternotomies.
• This case highlights the potential of sequential transcatheter interventions for complex valvular heart disease in high-risk surgical candidates.
• Further research into sequential transcatheter valve replacement strategies may expand treatment options for challenging cardiovascular cases.