Degenerative Bioprosthetic Steno-Insufficiency After Aortic Root Replacement Treated With Transcatheter Aortic Valve-in-Valve Replacement: A Case Report

A 52-year-old woman with Behet disease (BD) and aortic regurgitation (AR) visited our hospital with aggravated dyspnea.Approximately 12 years earlier, she had undergone aortic root replacement with a 25-mm stentless bioprosthetic valve (Edwards Prima stentless valve; Edwards Lifesciences Corp.).A 2-dimensional transthoracic echocardiogram (2DE) revealed thickening of the prosthetic valve and the presence of tiny tissue debris around the prosthesis, with notable increases in both peak velocity and mean pressure gradient.The patient appeared to exhibit degenerative changes in the implanted stentless bioprosthetic valve, leading to severe symptomatic aortic stenosis.Valve-in-valve transcatheter aortic valve replacement (TAVR) was chosen as the reintervention strategy due to the high surgical risk associated with redo surgery.A 29-mm Medtronic Corevalve Evolut R valve (Medtronic) was used for the procedure.Following TAVR, 2DE indicated reductions in both the mean pressure gradient and the peak velocity, and the patient's symptoms improved dramatically.This case underscores the potential of TAVR as an alternative to conventional redo surgery for patients with BD who require valve replacement with a bioprosthesis for AR.