892 TAVI in TAVI- A Single Centre Experience

Abstract

The use of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis is well established in clinical practice. However, there is a paucity in the literature of the procedural feasibility of repeat TAVI for late valve degeneration. Here we discuss three cases of patients who underwent TAVI in TAVI procedures. A 81 year old female who had a transapical balloon-expandable TAVI inserted 9 years prior presented with NYHA class 3 symptoms and recurrent admissions with decompensated heart failure. Echocardiography showed severe mixed aortic valve degeneration, and she subsequently underwent successful transfemoral valve in valve (ViV) TAVI. On 6 month follow-up she has NYHA class 1-2 symptoms with normal aortic valve hemodynamics. A 85 year old male with a self-expanding TAVI three years prior presented with recurrent decompensated heart failure. Echocardiography revealed severe transvalvular aortic regurgitation. He underwent a BASILICA (bioprosthetic or native aortic scallop to prevent iatrogenic coronary artery obstruction) and successful ViV-TAVI with a balloon expandable prosthesis, with favourable echocardiographic and symptomatic outcomes at 6 month follow-up. A 76 year old female with a previous TAVI procedure 8 years prior presented with NYHA class III symptoms and declining exercise tolerance, with echocardiography demonstrating severe aortic stenosis (mean gradient 87mmHg). Anticoagulation with warfarin was trialled for 3 months with no improvement, and she subsequently underwent ViV-TAVI with improvement in symptoms and favourable post implantation valve hemodynamics. These cases demonstrates procedural safety with improvement in patient symptoms and favourable post implantation hemodynamics, suggesting repeat TAVI is a feasible treatment option.