Redo-Transcatheter Aortic Valve Replacement for Migration of Myval Transcatheter Heart Valve in Pure Aortic Regurgitation.

Journal: JACC. Case Reports
Published:
Abstract

Background: A 76-year-old patient with severe symptomatic aortic regurgitation, deemed inoperable, was referred for transcatheter aortic valve replacement (TAVR).

Methods: Preprocedural computed tomography (CT) revealed a large, non-calcified native aortic annulus (31.7 mm), making commercially available transcatheter heart valves (THVs) unsuitable. A 32-mm (+2cc) Myval (Meril) THV was implanted with satisfactory immediate results. However, at day 7, delayed and asymptomatic migration into the left ventricular outflow tract (LVOT) with severe paravalvular leak (PVL) occurred. Given surgical ineligibility, a 29-mm (+6cc THV balloon overfilling) Sapien 3 (Edwards Lifesciences) THV was successfully deployed as a redo-TAVR strategy, anchoring the migrated index THV. One-month follow-up showed excellent outcomes.

Conclusions: Delayed THV migration in patients with native aortic regurgitation is a challenge. This case highlights redo-TAVR as a viable rescue strategy, using multimodal imaging and precise procedural techniques. Conclusions: Redo-TAVR is a safe and effective approach to address late THV migration into the LVOT in selected patients.