Management of Surgical Aortic Valve Replacement Degeneration With Transcatheter Aortic Valve Implantation (TAVI in SAVR): Experience in Nicaragua

Severe aortic valve stenosis poses a significant risk for the aging population, often escalating from mild symptoms to life-threatening heart failure and sudden death. Without timely intervention, this condition can lead to disastrous outcomes. The advent of transcatheter aortic valve implantation (TAVI) has gained popularity, emerging as an effective alternative for managing severe aortic stenosis (AS) in high-risk patients experiencing deterioration of previously implanted bioprosthetic surgical aortic valves (SAV), which introduces complex challenges such as device compatibility and anatomical considerations. We report the case of a 76-year-old male with a history of stage III hypertension, compensated type 2 diabetes, and aortic valve disease who underwent bioprosthetic valve replacement in 2013. His medications included metoprolol, metformin/glibenclamide, and levothyroxine. He presented with moderate exertional dyspnea (NYHA II) over four months, relieved by rest. Physical examination revealed a crescendo-decrescendo systolic murmur at the aortic focus. The aortic prosthesis stenosis was confirmed by a transthoracic echocardiogram. A CT angiogram showed bioprosthetic degeneration and significant calcification, allowing for transcatheter aortic valve implantation in the surgical aortic valve. The procedure was successfully performed via the transfemoral route using a 21.5 mm MyVal balloon-expandable valve. The intervention improved the patient's quality of life, resolving NYHA class III dyspnea and enabling greater independence in daily activities. Echocardiographic findings demonstrated a significant reduction in the transvalvular gradient, enhancing cardiac function and eliminating the immediate risk of valvular dysfunction progression, contributing to increased life expectancy and emotional well-being. This case highlights the feasibility and clinical benefits of transcatheter aortic valve implantation in surgical aortic valves for managing valve degeneration in a resource-limited setting, thereby representing a significant advancement in the treatment of aortic valve disease. The successful outcome demonstrates the importance of adopting innovative, minimally invasive techniques, particularly in regions with limited advanced interventions, by alleviating dyspnea, enhancing cardiac function, and significantly improving the patient's quality of life, emotional well-being, and prognosis.