# Successful Valve-in-Valve-in-Valve Transcatheter Aortic Valve Implantation for Severe Bioprosthetic Valve Restenosis in a High-Risk Patient

## TL;DR

A high-risk patient with repeated valve issues successfully underwent a third transcatheter valve procedure, showing the potential of this approach for complex cases.

## Contribution

Demonstrates the feasibility and safety of valve-in-valve-in-valve TAVI in a high-risk patient with recurrent bioprosthetic valve dysfunction.

## Key findings

- ViViV TAVI significantly improved hemodynamics, reducing transvalvular gradient from 80-90 mmHg to 15-20 mmHg.
- Effective orifice area increased from 0.4 cm² to 1.5 cm², and symptoms improved to NYHA Class I.
- Procedure was performed safely in a patient deemed at high surgical risk.

## Abstract

Transcatheter aortic valve implantation (TAVI) has significantly improved in treating aortic valve disease in recent years, particularly in patients at high surgical risk. This case report describes an 80-year-old woman who had severe aortic stenosis previously treated with surgical aortic valve replacement (SAVR) and six years later had a valve-in-valve (ViV) TAVI who developed severe symptomatic restenosis of the bioprosthetic aortic valve five years later of the last procedure. A third valve-in-valve-in-valve (ViViV) TAVI using a 26-mm Sapien 3 valve was performed due to the high surgical risk. The procedure resulted in significant hemodynamic improvement, reducing the transvalvular gradient from 80-90 mmHg to 15-20 mmHg and increasing the effective orifice area from 0.4 cm² to 1.5 cm². The patient’s symptoms improved to NYHA Class I. This case highlights the feasibility and safety of ViViV TAVI as a minimally invasive solution for recurrent bioprosthetic valve dysfunction in high-risk patients.