Recurrent severe aortic stenosis one year after transcatheter aortic valve-in-valve implantation: Successful treatment with balloon aortic valvuloplasty

Abstract

Transcatheter aortic valve-in-valve (VIV) implantation has evolved as one of the primary therapeutic modalities in patients with failed surgical bioprosthesis allowing a reduction in rate of surgical reintervention. We report a case of a 90-year-old woman who had previously undergone aortic valve replacement with 21-mm Carpentier-Edwards valve in 1999 followed by 23mm Sapien VIV in March 2013. She developed severe recurrent aortic stenosis 1-year post-VIV which was successfully treated with balloon aortic valvuloplasty (BAV). BAV can be a favorable treatment option allowing considerable symptomatic relief and improvement in performance of daily activities in extreme age patients who develop restenosis after VIV implantation and are high-risk candidates for both redo-surgical aortic valve replacement and redo-VIV implantation.<Learning objective: Transcatheter aortic valve-in-valve (VIV) implantation has become the most utilized surgical alternative in patients with failed bioprosthetic valves. However, known procedural complications include increased risk of coronary obstruction, elevated post-procedural gradients, and risk of valvular restenosis. Balloon aortic valvuloplasty allows significant symptomatic relief and can successfully be performed in patients developing severe symptomatic aortic valve restenosis following VIV implantation.>