Successful TAVI-in-TAVI for degenerated bioprosthetic aortic valve with severe stenosis-a case report

Abstract Aortic stenosis is one of the leading causes of valvular disease requiring surgery or transcatheter intervention, with a rising prevalence due to the aging population. Current guidelines recommend transcatheter aortic valve implantation (TAVI) as the first-line treatment for patients with symptomatic severe aortic stenosis and high surgical risk. The indications for TAVI have expanded to low-surgical-risk patients due to increased operator experience and improved implanted devices with a dramatic reduction of complications. Considering the limited durability of bioprostheses, TAVI-in-TAVI procedures have been successfully performed as an alternative to surgery. We present the case of an elderly patient who underwent a successful TAVI-in-TAVI for a degenerated bioprosthetic valve with severe stenosis. Multimodal imaging, including transthoracic echocardiography, transesophageal echocardiography, and cardiac computed tomography, played a crucial role in demonstrating the degeneration of the aortic bioprosthetic valve with severe stenosis. Excellent short- and long-term results were achieved by reducing transaortic gradients and improving the functional NYHA class. This case highlights the importance of proper patient selection using multimodality imaging and suggests the need for TAVI-in-TAVI to become an available and safe option for the management of a failed bioprosthesis valve.