Transcatheter Valve-in-Valve Repositioning of CoreValve ^® Evolut™ Rin Aortic Prosthesis

Abstract

A 41-year-old man with history of surgical replacement of the aortic valve with a 21mm-Mitroflow bioprosthesis (1A), presented with functional class IV heart failure. Transesophageal echocardiography confirmed severe bioprosthesis obstruction (1B). We implanted a 23mm-CoreValve® Evolut™ R (Medtronic, Minneapolis, USA) in the aortic bioprosthesis, by transfemoral approach. The valve was recaptured and repositioned during deployment (1C-E). Immediate (1F), one (1G) and three-month (1H) transthoracic echocardiography confirmed significant reduction in transaortic gradients. The patient remained in functional class I. Our experience in repositioning the valve during a valve-in-valve procedure demonstrates the usefulness of this resource in such challenging procedures.