Related Experiment Video
Updated: Oct 3, 2026

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
TAV-in-TAV-in-SAV in a Patient With Prior Mitral Valve-in-Valve
Rahul Gupta1, Kriti Soni1, Ronak Bharucha1
1Division of Cardiology, Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA.
Objective:
Successful deployment of a third self-expanding transcatheter aortic valve within a failed balloon-expandable valve in a surgical aortic valve bioprosthesis.
Key Steps:
Access and hemodynamics setup: 2 arterial and 1 venous access. Valve crossing and valvuloplasty: Cross the degenerated prosthetic valve complex without disrupting the mitral prosthesis to preserve its integrity, followed by valvuloplasty. Valve delivery and deployment: Transcatheter heart valve positioning utilizing fluoroscopic markers. Postdeployment assessment: Invasive hemodynamic assessment for assessment of transaortic gradient.
Potential Pitfalls:
Transcatheter aortic valve in transcatheter aortic valve in surgical aortic valve with prior mitral valve-in-valve without disrupting the mitral valve-in-valve integrity whilst still deploying the aortic valve-in-valve-valve successfully, based on the anatomical configuration of the 2 valves.
Take-Home Message:
Transcatheter aortic valve in transcatheter aortic valve in surgical aortic valve may be considered in selected high-risk patients, but coronary sequestration, cumulative frame geometry, and underexpansion require assessment.
Related Concept Videos
Mitral Stenosis III: Medical Management
Mitral Regurgitation I: Introduction
Mitral Regurgitation III: Medical Management
Mitral Valve Prolapse I: Introduction
Mitral Stenosis I: Introduction
Mitral Valve Prolapse II: Assessment and Management
