First Report of Evolut Pro+ Transcatheter Aortic Valve-in-Valve in a Degenerated Lotus Valve

Thorald Stolte; David Winkel; Philip Haaf; Thomas Nestelberger

doi:10.1016/j.shj.2023.100229

First Report of Evolut Pro+ Transcatheter Aortic Valve-in-Valve in a Degenerated Lotus Valve

Struct Heart. 2023 Nov 11;8(1):100229. doi: 10.1016/j.shj.2023.100229. eCollection 2024 Jan.

Authors

Thorald Stolte^{1

2}, David Winkel³, Philip Haaf¹, Thomas Nestelberger^{1

3}

Affiliations

¹ Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
² Department of Health Sciences and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland.
³ Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland.

Abstract

The increasing use of transcatheter aortic valves in patients with aortic stenosis has led to a higher number of valve-in-valve procedures due to gradual valve degeneration. We present a case of a 72-year-old woman who received transcatheter aortic valve implantation (TAVI) using a Lotus valve due to severe aortic stenosis, which showed valve degeneration several years after the initial procedure. After heart-team discussion, TAVI-in-TAVI was planned using an Evolut pro+ valve, which allowed for full coverage of the Lotus valve and maintenance of coronary flow, resulting in a well-functioning valve with no regurgitation and normal performance. Despite high-risk anatomic features, valve-in-valve using an Evolut pro+ in a degenerated Lotus valve is feasible and overcomes pitfalls such as entanglement or coronary obstruction.

Keywords: Functional computed tomography; Transcatheter aortic valve implantation; Valve prosthesis degeneration; Valve-in-valve.