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Updated: Jan 15, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Innovative Stent Reshaping With Dual Balloon Ovalization and Circular Reformation for Optimized Valve-in-Valve
Hadeel Allam1, Daisuke Kobayashi1, David T Balzer1
1Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri, USA.
Background:
Repeated transcatheter valve-in-valve (ViV) procedures risk progressive reduction in internal diameter, potentially leading to patient-prosthesis mismatch.
Case Summary:
We report 2 young adults with tetralogy of Fallot who developed dysfunction of previously placed SAPIEN pulmonary valves. Both underwent successful repeat transcatheter ViV implantation using the 29-mm SAPIEN 3 Ultra RESILIA valve after frame overexpansion. A double-balloon technique was used to ovalize the existing valve frame with two 18-mm high-pressure balloons, followed by circularization with a 28-mm balloon. Both patients had excellent immediate and 1-month outcomes.
Discussion:
To our knowledge, this is the first reported human use of a novel overexpansion technique in previously placed transcatheter valves. This technique has previously been reported in bench and animal models, and this approach may allow for preservation of valve diameter and optimize future ViV strategies.
Take-Home Messages:
The double-balloon technique enables safe overexpansion of SAPIEN valves. It may preserve long-term transcatheter treatment options for right ventricle to pulmonary artery conduit dysfunction.
