Self-expandable valve-in-valve transcatheter aortic valve implantation for a failed sutureless Perceval bioprosthesis: a case report

Background: Early structural degeneration of sutureless Perceval bioprostheses is uncommon but may result in severe haemodynamic compromise and heart failure. Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) represents a less invasive therapeutic option in high-risk patients. Case summary: A 78-year-old woman presented with progressive dyspnoea and lower-extremity oedema 3 years after surgical aortic valve replacement with a Perceval bioprosthesis. Transthoracic echocardiography revealed severe mixed prosthetic valve dysfunction with markedly elevated transvalvular gradients. Owing to prohibitive surgical risk, comprehensive preprocedural planning with echocardiography and multidetector computed tomography was performed to assess annular dimensions and coronary anatomy. A self-expandable ViV-TAVI was successfully performed, guided by fluoroscopic visualization of the Perceval inflow ring. Discussion: This case highlights the importance of understanding sutureless valve geometry and meticulous computed tomography-based planning when performing ViV-TAVI with a self-expandable transcatheter valve.