Successful valve-in-valve transcatheter aortic valve implantation using a hydra transcatheter aortic valve in a patient with severe degeneration of a surgical bioprosthesis: a case report

Bioprosthetic aortic valve degeneration is increasingly encountered and poses significant management challenges, particularly in elderly patients at high surgical risk [1]. Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) has emerged as an effective alternative to redo surgery in this complex population [1–3]. At the Cardiovascular centre, E Hospital, we report a case of 71-year-old man presenting with severe stenosis of a 21mm surgical bioprosthesis implanted 11 years earlier. Given the prohibitive risk of redo surgery [3], the Heart Team performed ViV-TAVI using a Hydra THV 22mm self-expanding transcatheter heart valve. The procedure was uneventful. At 15 days follow-up, transthoracic echocardiography demonstrated excellent hemodynamics performance with a peak transvalvular gradient of 9 mmHg and a mean gradient of 4 mmHg and the patient had returned to New York Heart Association (NYHA) functional class I. This case highlights the feasibility and favorable early outcomes of Hydra THV in ViV-TAVI for small surgical bioprostheses, a subgroup frequently associated with high residual gradients and patient–prosthesis mismatch [5–7]. This report aims to describe a Valve-in-Valve TAVI procedure in a small bioprosthetic valve, emphasize the role of multimodality imaging, evaluate post-procedural hemodynamic outcomes, and discuss potential complications and preventive strategies, with particular focus on coronary obstruction and patient–prosthesis mismatch.