Related Experiment Video
Updated: Mar 21, 2026
Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model
Published on: June 8, 2022
Transcatheter Aortic Valve Replacement in a Failed Homograft
Maximilian Reisinger1, Jay Vance2, Thomas Gilliland2
1Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont, USA; Department of Internal Medicine, University of Vermont Medical Center, Burlington, Vermont, USA.
Background:
Surgical reintervention for degenerated aortic homografts is associated with high operative risk. Transcatheter aortic valve replacement (TAVR) offers a less invasive alternative but is technically challenging with current-generation devices.
Case Summary:
A 72-year-old man with history of aortic homograft replacement presented with acute dyspnea due to severe aortic regurgitation (AR). Valve-in-valve TAVR was performed (29-mm Evolut FX+), with mild paravalvular AR. Subsequent transesophageal echocardiography revealed supra-annular valve position with a prolapsing, uncovered homograft leaflet, causing recurrent severe AR. Bailout redo-TAVR was performed (26-mm Sapien S3 Ultra) with intentional deployment at a deeper position, leading to successful AR resolution.
Discussion:
This case demonstrates the technical difficulties with TAVR in failed aortic homografts, especially when the failure mechanism is AR. Owing to lack of leaflet calcification and difficulty with visualization, TAVR using commercial devices is associated with risk of valve malposition and need for a second valve.
Take-Home Message:
Dedicated TAVR devices for AR will likely become the preferred treatment for failed homografts after commercial approval.
