Abstract 11715: Valve-in-Valve Transcatheter Aortic Valve Implantation for Early Valve Degeneration

Case Presentation: A 64-year-old woman with presented to the hospital with chest pain and hypotension during hemodialyis. Three months prior to presentation, she had underwent transcatheter aortic valve implantation (TAVI) and received a 26 mm CoreValve Evolut Pro (Medtronic, MN) for severe aortic stenosis. She was admitted to the cardiac intensive care unit and underwent diagnostic testing. Transthoracic echocardiography demonstrated a new mean transaortic valve gradient of 55 mm Hg (Figure 1A), increased from her post-procedural gradient of 12 mm Hg. Despite empiric treatment with heparin anticoagulation and antibiotics, the patient did not improve clinically. CT imaging did not reveal valve thrombosis, endocarditis, or any other structural deformities (Figure 1B), and the patient’s mean transaortic valve gradient worsened to 73 mm Hg. After a multidisciplinary discussion, a decision was made to offer a valve-in-valve TAVI for early valve degeneration with a 23 mm Sapien S3 (Edwards, CA) valve (Figure 1C). After her procedure, the patient’s symptoms resolved and she was discharged from the hospital. The patient’s mean transaortic valve gradient improved to 12.6 mm Hg at her 4 month follow up visit (Figure 1D). Discussion: Early TAVI valve dysfunction is typically attributed to thrombus or infection of the valve. Here we present a case of valve dysfunction that was not related to either of these etiologies. Delineating the cause of her valve dysfunction was vital to her therapeutic decision making. Since the patient was not a surgical candidate, valve-in-valve TAVI was offered when thrombus and endocarditis were eliminated as the etiology of her valve dysfunction.