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Article history: Transcatheter aortic valve-in-valve (VIV) implantation has evolved as one of the primary therapeutic
Received 1 September 2015 modalities in patients with failed surgical bioprosthesis allowing a reduction in rate of surgical
Received in revised form 12 February 2016 reintervention. We report a case of a 90-year-old woman who had previously undergone aortic valve
Accepted 9 March 2016
replacement with 21-mm Carpentier-Edwards valve in 1999 followed by 23 mm Sapien VIV in March
2013. She developed severe recurrent aortic stenosis 1-year post-VIV which was successfully treated
Keywords: with balloon aortic valvuloplasty (BAV). BAV can be a favorable treatment option allowing considerable
Valve-in-valve
symptomatic relief and improvement in performance of daily activities in extreme age patients who
Aortic stenosis
Balloon
develop restenosis after VIV implantation and are high-risk candidates for both redo-surgical aortic
Valvuloplasty valve replacement and redo-VIV implantation.
Transcatheter aortic valve 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.>
ß 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jccase.2016.03.013
1878-5409/ß 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
36 A. Badami et al. / Journal of Cardiology Cases 14 (2016) 35–37
transesophageal echocardiograms showed evidence of a thrombus. [2] Duncan A, Davies S, Di Mario C, Moat N. Valve-in-valve transcatheter aortic
valve implantation for failing surgical aortic stentless bioprosthetic valves: a
Of note, after the initial TAVI procedure using a 23 mm Sapien VIV single-center experience. J Thorac Cardiovasc Surg 2015;150:91–8.
implant, the patient was started on aspirin 81 mg per oral (PO) [3] Gurvitch R, Cheung A, Bedogni F, Webb JG. Coronary obstruction following
daily and clopidogrel 75 mg PO daily. Clopidogrel was discon- transcatheter aortic valve-in-valve implantation for failed surgical bioprosth-
eses. Catheter Cardiovasc Interv 2011;77:439–44.
tinued after 6 months but she continued to be on aspirin 81 mg PO [4] Azadani AN, Jaussaud N, Matthews PB, Ge L, Chuter TA, Tseng EE. Transcatheter
daily at the time of presentation. aortic valves inadequately relieve stenosis in small degenerated bioprostheses.
Considering the advanced age and multiple comorbidities, we Interact Cardiovasc Thorac Surg 2010;11:70–7.
[5] Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal
decided to proceed with BAV for treating the severe symptomatic prosthesis and long-term management. Circulation 2009;119:1034–48.
post-VIV restenosis. Although her post-BAV transvalvular velocity [6] Latib A, Ielasi A, Montorfano M, Maisano F, Chieffo A, Cioni M, Mussardo M,
and pressure gradients remained high, she was able to achieve Bertoldi L, Shannon J, Sacco F, Covello RD, Figini F, Godino C, Grimaldi A,
Spagnolo P, et al. Transcatheter valve-in-valve implantation with the Edwards
significant symptomatic relief with successful return to her daily
SAPIEN in patients with bioprosthetic heart valve failure: the Milan experi-
activities. She remains clinically asymptomatic to date, which ence. EuroIntervention 2012;7:1275–84.
signifies the importance of BAV as a successful treatment strategy [7] Dvir D, Webb JG, Bleiziffer S, Pasic M, Waksman R, Kodali S, Barbanti M, Latib A,
for VIV restenosis in elderly, high surgical risk patients. Schaefer U, Rodés-Cabau J, Treede H, Piazza N, Hildick-Smith D, Himbert D,
Walther T, et al. Transcatheter aortic valve implantation in failed bioprosthetic
surgical valves. JAMA 2014;312:162–70.
Conflict of interest [8] Camboni D, Holzamer A, Flörchinger B, Debl K, Endeman D, Zausig Y, Maier LS,
Schmid C, Hilker M. Single institution experience with transcatheter valve-in-
valve implantation emphasizing strategies for coronary protection. Ann
The authors declare that there is no conflict of interest. Thorac Surg 2015;99:1532–8.
[9] Mylotte D, Andalib A, Thériault-Lauzier P, Dorfmeister M, Girgis M, Alharbi W,
Chetrit M, Galatas C, Mamane S, Sebag I, Buithieu J, Bilodeau L, de Varennes B,
References Lachapelle K, Lange R, et al. Transcatheter heart valve failure: a systematic
review. Eur Heart J 2015;36:1306–27.
[1] Svensson LG, Tuzcu M, Kapadia S, Blackstone EH, Roselli EE, Gillinov AM, Sabik [10] Martı́ D, Rubio M, Escribano N, de Miguel R, Rada I, Morı́s C. Very late
3rd JF, Lytle BW. A comprehensive review of the PARTNER trial. J Thorac thrombosis of a transcatheter aortic valve-in-valve. J Am Coll Cardiol Interv
Cardiovasc Surg 2013;145:S11–6. 2015;8:e151–3.