Late Transcatheter Valve Migration Managed With Redo TAVR: A Case of Triple Aortic Valve Replacement

Valve-in-valve-in-valve procedures, typically due to late transcatheter valve degeneration, are infrequently reported.

A 76-year-old man underwent surgical aortic valve replacement in 2016 with a 25-mm Mitroflow bioprosthesis for severe aortic stenosis. Eight years later, he developed acute heart failure due to severe aortic regurgitation from prosthetic degeneration. A valve-in-valve (ViV) procedure was successfully performed using a 25-mm self-expandable Navitor valve. Ten months later, he experienced recurrent symptoms. Imaging revealed late downward migration of the transcatheter valve, resulting in severe paravalvular leak and moderate ventricular dysfunction. The heart team decided to proceed with a repeat ViV procedure using a second self-expandable valve.

Although ViV is an established alternative to redo surgery, evidence on outcomes after a second procedure is limited.

Careful imaging, anatomical assessment, and strategic planning are critical to ensure success in third-time transcatheter aortic valve replacement.