Management of bioprosthetic valve failure at 10 years after TAV-in-SAV

Structural deterioration of bioprosthetic heart valves, manifesting as stenosis and/or regurgitation, remains the primary factor limiting valve longevity. As patients undergoing valve replacement have increasingly longer life expectancies, planning lifelong management is essential1. This trend also highlights the need to balance surgical and transcatheter options in redo procedures, which is an evolving conversation in which transcatheter options may offer a less invasive alternative to surgery2. Here, we report a challenging case in the lifelong management of aortic valve disease of a 66-year-old female with significant comorbidities, including chronic kidney disease, end-stage liver disease, and a complex cardiac history.

The patient was initially treated at the age of 47 due to native aortic valve endocarditis, necessitating surgical aortic valve replacement (SAVR) with a 21 mm Carpentier-Edwards PERIMOUNT (Edwards Lifesciences). The procedure involved root enlargement and congenital ventricular septal defect repair, complicated by coagulopathy, leading to a prolonged hospital stay but a favourable overall outcome. Nine years later, at age 56, she underwent a transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV) procedure, owing to the risk of coronary obstruction and sinus sequestration...