Transcatheter aortic valve implantation for aortic stenosis has evolved as an alternative treatment for patients who are at high or excessive surgical risk. We report the case of an 84-year-old man with a degenerated surgically implanted valve in a subaortic position (9 mm below the native annulus) who underwent "valve-in-valve" transcatheter aortic valve implantation with use of a Medtronic CoreValve system. We planned to deploy the Core-Valve at a conventional depth in the left ventricular outflow tract; we realized that this might result in paravalvular regurgitation, but it would also afford a "deep" landing site for a second valve, if necessary. Ultimately, we implanted a second CoreValve deep in the left ventricular outflow tract to seal a paravalvular leak. The frame of the first valve-positioned at the conventional depth-enabled secure anchoring of the second valve in a deeper position, which in turn effected successful treatment of the failing subaortic surgical prosthesis without paravalvular regurgitation.

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Texas Heart Institute Journal
Erasmus MC: University Medical Center Rotterdam

Nuis, R.-J., Benitez, J., Nader, C. A., Perez, S., de Marchena, E., & Dager, A. (2013). Valve-in-Valve-in-Valve transcatheter aortic valve implantation; to treat a degenerated surgical bioprosthesis in a subaortic position. Texas Heart Institute Journal, 40(3), 323–325. Retrieved from