A patient with degenerated aortic (Trifecta™ 23 mm; St. Jude Medical, St. Paul, MN, USA) and mitral (Edwards PERIMOUNT 25 mm; Edwards Lifesciences, Irvine, CA, USA) valve bioprostheses was referred and deemed high risk for open heart surgery (logistic EuroSCORE 17.6% and frailty). The Heart Team decided on transapical double valve-in-valve.
Due to the heavy calcification on the degenerated leaflets, a cerebral protection device (Sentinel CPS; Claret Medical, Santa Rosa, CA, USA) was used (Panel A). Two 23 mm Edwards SAPIEN 3 valves (Edwards Lifesciences) were directly deployed (no balloon valvuloplasty) in the failing aortic prosthesis (reduction of mean gradient from 40 mmHg ...
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