Transcatheter aortic valve intervention (TAVI) over delayed TAVI, an emerging solution. Valve in valve, Case report.

Abstract

Introduction: Degenerative aortic stenosis is the most common acquired heart valve disease in the elderly population. Its prevalence in people over 80 years of age is >4%. In symptomatic patients, aortic valve replacement has been the treatment of choice. However, up to 60% of cases are considered too high surgical risk to undergo open surgery. Transcatheter implantation of an aortic valve is a standard therapy. However, this procedure has a prevalence of complications of 2-8% and a risk of mortality up to 2 or 3 times. The case of an acute complication resolved with a second prosthesis is presented.

Clinical case: An 82-year-old man with significant comorbidities (high blood pressure, obesity, sedentary lifestyle, peripheral arterial disease, and heart failure) presented rapid progression of his dyspnea and exertional angina. Severe aortic stenosis (aortic valve area of ​​0.64 cm²) was diagnosed with an indication for valve replacement. Given the high associated morbidity, TAVI was chosen; the preoperative risk scores (EuroSCORE 11.66% and STS 10.2%) reflected the case's complexity. During the procedure, infra-annular displacement of the prosthesis was observed, resulting in severe transvalvular aortic insufficiency. Despite balloon dilation, the prolapse was not corrected, so a second prosthesis was immediately implanted, achieving adequate fixation and eliminating the valve leak.

Conclusion:  Emergent Valve in valve implantation is a viable option for determining patient survival in severe regurgitation cases. Treating transvalvular regurgitation is based on a shared decision-making process in which a multimodality approach and clinical characteristics play a crucial role. Future studies addressing and comparing different treatment approaches are warranted.