Valve In Valve Transaortic Valve Replacement (ViV-TAVR) in a Patient with Recurrent Pulmonary Edema: A Novel Procedure That Could Be Effective and Life-Saving in High-Risk Patients

Abstract

Background: Bio-prosthesis is the method of choice in managing aortic valve stenosis due to THE lesser probability of coagulation, even though higher valve replacement rates are undeniable. Valve-in-Valve Surgical Valve Replacement (ViV-SAVR) is shown to have lower rates of mortality than reoperation. We have reported a patient undergoing a ViV-SAVR procedure with exceptionally better results than in the literature. Case presentation: A 73-year-old Caucasian female was admitted with dyspnea and pulmonary edema with a bioprosthetic Mitroflow valve stented 10 years before admission. The echocardiography showed ejection fraction = 30%, left ventricular end-diastolic volume = 135 mL, LVEDV index = 72.9 mi∕m2, degenerated aortic valve with severe transvalvular aortic regurgitation, and mild aortic stenosis (mean gradient = 19 mmHg, peak gradient = 36 mmHg). The prosthetic valve was positioned on the previous Mitroflow bioprosthetic valve strut, followed by aortography. The patient was followed up for one month using transesophageal echocardiography, with no paravalvular leakage. Aortic transvalvular mean gradient of 16 mmHg and EOA of 1.3 cm2. Conclusion: ViV-SAVR is a method of treating aortic valve stenosis, which, if performed correctly, can enhance the survival and quality of life of the patients.