Failing transcatheter aortic valve treated by transcatheter aortic valve in transcatheter aortic valve (TAV-in-TAV) implantation: valve safety versus valve durability

We present the case of a 67-year-old male who presented with a degenerated 29 mm CoreValve (Medtronic, Minneapolis, MN, USA) five years after its successful implantation for severe bicuspid aortic valve stenosis (Online Figure 1). During the most recent hospitalisation, for an acute coronary syndrome, transoesophageal echocardiography (TEE) detected a new-onset severe transvalvular AR due to a prolapsing bioprosthetic valve leaflet (Figure 1A, Figure 1B, Figure 1F, Moving image 1). Signs and symptoms suggestive of endocarditis were absent. The Heart Team decided to proceed with a transcatheter aortic valve in transcatheter aortic valve (TAV-in-TAV) implantation using a 29 mm CoreValve prosthesis (Figure 1C). Contrast ...