Successful Rescue Transaortic Valve Replacement Using Edwards Sapien 3 Following Failed Evolut R Implantation in a...

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• Structural valve degeneration (SVD) in surgical bioprosthetic aortic valves presents challenges, particularly in high-risk patients.
• This study focuses on a patient with a degenerated Carpentier-Edwards Perimount Magna Ease valve experiencing paravalvular leak (PVL) and prosthetic valve insufficiency (PVI).

Observation:

• A transaortic valve-in-valve (ViV) procedure was attempted using a Medtronic Evolut R valve.
• Complications arose due to Evolut R malpositioning and migration into the left ventricular outflow tract (LVOT) after a bioprosthetic valve fracture (BVF) attempt.
• This led to acute severe PVL and hemodynamic compromise.

Findings:

• An emergent implantation of an Edwards SAPIEN 3 valve successfully resolved the severe PVL and hemodynamic instability.
• The intervention avoided the need for surgical valve explantation.

Implications:

• This case underscores the complexities of ViV procedures in SVD management.
• It demonstrates critical emergency management strategies for transcatheter aortic valve replacement (TAVR) complications.
• Insights are provided for handling challenging ViV implantations and associated leaks.