Emergency Transcatheter Aortic Valve in Sutureless Valve Replacement for Managing Cardiogenic Shock

Sutureless aortic bioprosthesis (SBVs) may pose specific challenges to valve-in-valve (ViV) implantation, particularly, in the setting of cardiogenic shock which remains challenging and understudied. We report the case of a 69-year-old man with a SBVs disfunction, presenting with acute decompensated HF. Despite intra-aortic balloon pump (IABP), clinical deterioration prompted an emergency transcatheter ViV. Computer tomography imaging confirmed procedural feasibility. A self-expanding Evolut PRO+ valve was deployment followed by post-dilatation for underexpansion. The procedure restored valve function, and the patient was weaned off IABP. At 30-day follow-up, patient was in NYHA class I with complete recovery of left ventricular systolic function. This is the first reported case of emergency ViV for a degenerated sutureless valve. Careful CT planning and device selection are critical. Despite the lack of data in this setting, ViV may represent a safe and effective option for high-risk patients in cardiogenic shock.