Degenerated Stentless Bioprosthetic Aortic Valve: Transcutaneous aortic Valve-in-Valve Implantation

Transcatheter aortic valve replacement (TAVR) is an established procedure for the treatment of patients with severe symptomatic aortic stenosis (AS) at prohibitive or high operative risk for conventional surgical valve replacement (sAVR), improving survival and quality of life. Since the introduction of TAVR, several reports have suggested that off-label use of TAVR for degenerated surgically inserted bio-prosthetic valves (valve-in-valve) is feasible and effective. However, unlike stented bio-prosthetic valves, a stentless valve has no rigid metallic ring for the anchoring of the new prosthesis and no visual landmarks to guide its positioning making such a procedure very demanding.

In this month’s Journal of Invasive Cardiology, we present an interesting case of Transfemoral Aortic Valve-in-Valve Implantation in a Degenerated Stentless Bioprosthetic Valve. Our case demonstrates that valve-in-valve replacement in stentless bioprothetic aortic valves is a feasible, however technically demanding, procedure and that TEE guidance in the absence of fluoroscopic landmarks is of paramount importance. For these reasons, Valve-in-Valve procedures should be undertaken only at experienced centers.

Halapas A, Chrissoheris M, Spargias K. Challenging Transfemoral Valve-in-Valve Implantation in a Degenerated Stentless Bioprosthetic Aortic Valve. J INVASIVE CARDIOL 2014 Aug;26(8):E106-8.

A selection of “Valve-in-Valve” articles available at

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