A Case of Valve-in-Valve-in-Valve for Severe Aortic Regurgitation: Is Lifetime Management Upon Us?

Background: The incremental use of transcatheter aortic valve replacement will inexorably lead to structural valve deterioration and the need for both a second and third valvular interventions, raising the question of feasibility. Case summary: We present the case of a 76-year-old man that presented with cardiogenic shock refractory to inotropic support. His workup revealed severe bioprosthetic aortic regurgitation 5 years after undergoing transcatheter aortic valve-in-valve implantation. After confirming anatomical suitability with multimodality imaging, he underwent uncomplicated valve-in-valve-in-valve (ViViV) implantation of a 23 mm Edwards S3 Ultra valve with rapid clinical improvement. Conclusions: Whether in the form of stenosis or severe regurgitation as in our patient, ViViV is feasible. Careful preprocedural planning and confirmation of anatomical suitability with multimodality imaging are key for success and safety. (c) 2022 Elsevier Inc. All rights reserved.