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Index Transcatheter Aortic Valve Expansion After TAV-in-TAV Using a One-Size-Smaller SAPIEN Valve
Kentaro Mitsui1, Atsushi Okada2, Naonori Kawamoto3
1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Background:
Index transcatheter aortic valve (TAV) expansion during TAV-in-TAV is crucial as it changes the valve-to-aorta distances and may increase the intraprocedural risk.
Case Summary:
A TAV-in-TAV procedure was planned for a 90-year-old woman with prior TAV replacement (23-mm SAPIEN XT) who presented with prosthetic valve stenosis. Second TAV sizing was assessed by averaging the stent areas of the index TAV and by drawing a virtual circle on preprocedural computed tomography (CT). CT imaging also revealed significant calcification of the index TAV leaflets. The team opted for a one-size-smaller 20-mm SAPIEN3 valve. During the procedure, the index TAV expanded by creating a gap between the 2 valve stents. Postprocedural CT confirmed index TAV expansion and the calcified leaflets in the gap, which likely facilitated the expansion.
Discussion:
Our case highlights the importance of considering leaflet calcification of the index TAV when planning TAV-in-TAV, which includes second TAV sizing and predicting index TAV expansion.
