A transcatheter “sandwich” valve-in-valve implantation for pure aortic regurgitation: a report of 2 cases

Abstract

The application of transcatheter aortic valve replacement (TAVR) for severe pure native aortic valve regurgitation (PNAR) remains limited. TAVR for PNAR using an off-label device is associated with acceptable procedural success but increased early mortality. For performing TAVR for PNAR patients, appropriate anatomy, especially a relatively small aortic annulus, is a necessary condition for successful procedure, and large aortic annulus is generally excluded. Here, we report using a new transcatheter “sandwich” valve-in-valve implantation technique with commercially available devices for treating two cases of PNAR, including one with a extremely large aortic annulus (namely aortic annulus perimeter over 91.1 mm, respectively, according to the industry instructions VitaFlow®). The conditions of both patients improved, and there were no complications during the follow-up periods. The new transcatheter “sandwich” valve-in-valve implantation technique using the commercially available self-expanding devices could be an option for treating PNAR patients with an extremely large annulus at high risk for surgery. This technique can also be an effective remedy for the first valve to be placed too high and jump up to the ascending aorta.