Emergency Transcatheter Aortic Valve Implantation in a Surgical Aortic Bioprosthetic Valve for Acute Decompensated Heart Failure Caused by Sudden Progression of Structural Valve Deterioration

Abstract

Bioprosthetic aortic valves have limited durability. We herein report sudden progression of structural valve deterioration (SVD) and a successful case of emergency transcatheter aortic valve (TAV) implantation for acute decompensated heart failure (ADHF) caused by SVD. A 79-year-old man who had undergone a Bentall operation 11 years prior was diagnosed with ADHF due to suddenly progressive SVD. Emergency TAV implantation in the surgical bioprosthetic valve was selected based on the surgical risk. Ours and previous case reports suggest that SVD can progress suddenly, even after months of stability, and that emergency TAV implantation is effective.

Transcatheter Structural Heart Interventions in the Acute Setting: An Emerging Indication

“…Transcatheter interventions have been considered in cases of degenerated prosthetic valves, with particularly limited experience and in patients of prohibitive surgical risk. In cases of degenerated aortic prostheses and an emergent setting, there have been several case reports on patients with endocarditis [ 83 , 84 ], early failure of the prosthetic valve [ 85 ], and acute decompensated HF or CS secondary to structural valve dysfunction [ 86 , 87 , 88 , 89 ]. Although in these instances the feasibility of TAVI has been proven, no case series or observational study has thoroughly evaluated this potential TAVI indication.…”