# Transcatheter aortic valve implantation for structural valve deterioration of homograft surgical aortic valve using SAPIEN3 Ultra RESILIA: a case report

## TL;DR

This case report describes a successful transcatheter aortic valve implantation using a new valve to treat a deteriorated homograft valve in an elderly patient with heart failure.

## Contribution

The novelty lies in using the SAPIEN3 Ultra RESILIA valve, which reduces paravalvular leakage, for treating homograft structural valve deterioration.

## Key findings

- TAVI using SAPIEN3 Ultra RESILIA achieved trace paravalvular regurgitation and improved valve function.
- The new valve design significantly reduces paravalvular leakage compared to older models.
- Device success was achieved with favorable post-operative effective orifice area measurements.

## Abstract

There are a few case reports regarding transcatheter aortic valve implantation (TAVI) for deteriorated surgical homograft.

We present a case of severe structural valve deterioration (SVD) of homograft surgical aortic valve presenting severe aortic regurgitation in an 84-year-old man with decompensated heart failure. We performed TAVI in homograft valve using 23 mm SAPIEN3 Ultra RESILIA. The resulting grade of paravalvular regurgitation was trace, the post-operative effective orifice area (EOA) was 1.66 cm2 (index EOA: 1.19 cm2/m2), and device success was achieved.

Stented bioprosthetic valves are more commonly implanted than mechanical and stentless bioprosthetic valves. In the 1980s and the early 1990s, homografts became particularly popular as alternatives to stented valves. There are several reports of TAVI for homograft SVD, but the paravalvular leakage grade is worse than that of redo-surgical aortic valve replacement, although the mortality rate is lower. However, the valves used in these reports were from older valves such as SAPIEN XT or SAPIEN3. There are no reports using SAPIEN3 Ultra RESILIA with a significant reduction in paravalvular leak due to an external textured polyethylene terephthalate skirt extending 40% higher above the valve inflow than the classical SAPIEN3, which is now available. Transcatheter aortic valve implantation using SAPIEN3 Ultra RESILIA showed good therapeutic efficacy.