Related Experiment Video
Updated: Jun 5, 2026

Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model
Published on: June 8, 2022
Valve-in-Valve TAVR for Degenerated Perceval Valves: From Entrapment to Success
Mouna Kodali1, Rajesh Gutpa1, Ahmad Mahdi1
1Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, USA.
Background:
Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is an established treatment option for bioprosthetic valve failure. The sutureless Perceval bioprosthesis presents unique technical challenges because of the valve's supra-annular nitinol ring, lack of radiopaque markers, and potential difficulty with central valve crossing and entrapment of devices within the supra-annular ring.
Case Summary:
We report 2 cases of Perceval degeneration managed with ViV-TAVR using balloon-expandable Edwards Sapien 3 Ultra valves. In the first case, standard retrograde crossing led to delivery system entrapment despite multiple conventional methods for assessing central crossing, requiring multiple complex bailout maneuvers including balloon-assisted displacement and TAVR delivery system snaring. In the second case, after failed central retrograde crossing, antegrade transseptal approach with arteriovenous loop formation enabled precise central crossing. After wire externalization via the femoral artery, standard retrograde TAVR delivery and successful valve deployment were performed without complication. Both patients experienced favorable outcome and symptom resolution at follow-up.
Take-Home Messages:
These cases highlight the importance of preprocedural planning, advanced imaging guidance, and alternative access and crossing strategies when performing ViV-TAVR in Perceval valves. The antegrade approach may be safer, is reproducible, and saves on procedure time.
Related Concept Videos
Mitral Stenosis III: Medical Management
Mitral Valve Prolapse I: Introduction
Mitral Valve Prolapse II: Assessment and Management
Aortic Regurgitation I: Introduction
Mitral Regurgitation I: Introduction
Aortic Regurgitation III: Medical Management
