Abstract
BackgroundValve-in-valve transcatheter aortic valve implantation for degenerated aortic bioprostheses is an effective option for patients at high risk for redo surgery, even if it may be burdened by complications more common in specific settings, such as, coronary artery obstruction.Case presentationWe present the case of a Caucasic 84-year-old woman with degeneration of a previously implanted aortic Mitroflow bioprosthesis. She underwent a valve-in-valve transcatheter aortic valve implantation with a CoreValve® bioprosthesis. End-procedure coronary angiography demonstrated maintained perfusion of both coronary arteries. However, few hours later, she experienced sudden cardiac death. An autopsy showed that Mitroflow prosthesis leaflets were higher than the left main coronary ostium, and no other possible cause for the sudden death. Fatality was thus ascribed to left main coronary ostium obstruction due to apposition of the Mitroflow leaflet pushed upward by the late expansion of CoreValve®.ConclusionsCoronary artery obstruction is a frequently fatal complication which usually presents just after valve implantation, but, as reported in our case, it may also have a delayed presentation. Accurate patient’s selection and intraoperative preventive measures can reduce this eventuality.
Highlights
Valve-in-valve transcatheter aortic valve implantation for degenerated aortic bioprostheses is an effective option for patients at high risk for redo surgery, even if it may be burdened by complications more common in specific settings, such as, coronary artery obstruction.Case presentation: We present the case of a Caucasic 84-year-old woman with degeneration of a previously implanted aortic Mitroflow bioprosthesis
In recent years, valve-in-valve (VIV) transcatheter aortic valve implantation (TAVI) procedures for correction of degenerated aortic bioprostheses appeared to be a feasible and satisfactory option for patients deemed at high risk for redo surgery [1]
Case presentation We report the case of a retired Caucasic 84-year-old woman who required a VIV procedure due to the degeneration of a previously implanted aortic bioprosthesis
Summary
VIV TAVI for previously implanted degenerated aortic bioprostheses is a satisfactory alternative method to the repeating of surgery, it is less invasive and has a high rate of procedural success. Coronary obstruction, a life-threatening complication, seems to occur more frequently in VIV than in native valve TAVI. This complication usually occurs at the time of implantation, but, as reported in our case, it may have a delayed presentation. This highlights the importance of adequate preoperative selection of patients as a means of prevention. Authors’ contributions All authors read and approved the final manuscript. Ethics approval and consent to participate Approval of the institutional ethics committee was not required, because this is a case report without any experimental trial. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
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