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Published on: April 23, 2014
A TAV-in-TAV-in-SAV Lifetime Management
Emiliano Bianchini1, Mairead Linnane1, Sara Sgreva1
1Department of Cardiology, National University of Ireland Galway (NUIG), Galway, Ireland.
Background:
Knowledge of prior valve design and failure mechanisms, as well as accurate multislice computed tomography (MSCT)-based planning are critical to optimize reintervention strategies in lifetime management of aortic stenosis.
Case Summary:
A 79-year-old man with prior surgical aortic valve (SAV) replacement in 2008 (27-mm Epic, Abbott) and transcatheter aortic valve (TAV)-in-SAV in 2019 (25-mm Lotus Edge, Boston Scientific) presented with acute heart failure. Echocardiography reported a severely stenotic Lotus valve, with evident asymmetrical underexpansion on MSCT. Optimization of Lotus expansion and Epic fracture was achieved with a 25-mm noncompliant balloon, followed by implantation of a 29-mm Evolut FX+, and then postdilatation with a 24-mm noncompliant balloon. Postprocedure MSCT demonstrated 25% increase in Lotus expansion at the midframe level, and symmetrical leaflet expansion of the Evolut, resulting in an echocardiographic gradient of 6 mm Hg after discharge.
Discussion:
Surgical valve fracture via an underexpanded Lotus is feasible and affords symmetrical expansion of complex TAV-in-TAV-in-SAV combinations with optimal hemodynamics.
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