Transcatheter Aortic Valve-in-Surgical Aortic Valve (TAV-in-SAV) for Structural Valve Degeneration of Post-Surgical Aortic Valve Replacement (SAVR) With the 3D-Nicks Procedure: A Case Report

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Publication Details

Journal
Cureus
Published
2026-09-08
DOI
https://doi.org/10.7759/cureus.115943
Primary Topic
Cardiac Valve Diseases and Treatments
Type
article
Field-Weighted Citation Impact
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article

Transcatheter Aortic Valve-in-Surgical Aortic Valve (TAV-in-SAV) for Structural Valve Degeneration of Post-Surgical Aortic Valve Replacement (SAVR) With the 3D-Nicks Procedure: A Case Report

Atsuo Mori, Tadashi Omoto, Tomoaki Masuda, Daisuke Itakura et al.
Cureus
Cardiac Valve Diseases and Treatments
article

Transcatheter Aortic Valve-in-Surgical Aortic Valve (TAV-in-SAV) for Structural Valve Degeneration of Post-Surgical Aortic Valve Replacement (SAVR) With the 3D-Nicks Procedure: A Case Report

Atsuo Mori, Tadashi Omoto, Tomoaki Masuda, Daisuke Itakura, Motoki Fukutomi
article en

Abstract

Transcatheter aortic valve implantation (TAVI) for structural valve deterioration (SVD) following surgical aortic valve replacement (SAVR) is an established alternative to redo surgery (transcatheter aortic valve-insurgical aortic valve, or TAV-in-SAV).However, in patients with a small aortic annulus or small sinus of Valsalva (SOV), the risk of coronary artery obstruction or severe prosthesis-patient mismatch (PPM) remains a major constraint.To address this, we previously introduced the "3D-Nicks" procedure, using a preoperatively prepared three-dimensional ellipsoidal patch to achieve circumferential aortic root enlargement.We report a 14-year successful clinical course of TAV-in-SAV following SAVR with the 3D-Nicks procedure.A 61-year-old woman with severe aortic valve stenosis (AS) and a narrow aortic root (annulus 19 mm, STJ 20 mm) underwent SAVR (CEP19 ® mm, Edwards Lifesciences, Irvine, CA) combined with the 3D-Nicks technique.Around 14 years postoperatively, she developed severe SVD.Contrast CT demonstrated that 3D-Nicks had maintained ample root geometry (SOV 30.2-36.8 mm, STJ 31.8 mm, VTC > 5.0 mm, VTSTJ > 6.0 mm).TAV-in-SAV was successfully performed using a 23 mm Evolut FX ® valve (Medtronic, Minneapolis, MN) via transfemoral access without coronary protection.Postoperative echocardiography showed excellent hemodynamics (mean PG 6 mmHg, EOAi 1.29 cm²/m²), which remained stable at the three-year follow-up (EOAi 1.16 cm²/m²).This case highlights that the 3D-Nicks procedure may provide favorable three-dimensional aortic root dimensions that facilitate safe long-term TAV-in-SAV.

Cureus
SHOWA Medical University (JP), Kawasaki Municipal Hospital (JP), Kawasaki Hospital (JP), SHOWA Medical University Hospital (JP)
Openalex Percentile: Top 11%
Cardiac Valve Diseases and Treatments
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