# A Case Series of Valve‐in‐Valve Transcatheter Aortic Valve Replacement in Stentless Bioprosthetic Valves Using Self‐Expanding Platform With Minimalist Approach

## TL;DR

This paper reports on the successful use of a self-expanding valve in a minimally invasive procedure to replace failed aortic valves in high-risk patients.

## Contribution

The study demonstrates the feasibility and safety of using the AN2 valve for ViV TAVR in stentless bioprosthetic valves.

## Key findings

- All three patients underwent successful ViV TAVR with no major complications.
- There was no stroke, mortality, or need for a pacemaker within 30 days.
- Patients showed significant functional and symptomatic improvement post-procedure.

## Abstract

Valve‐in‐valve (ViV) Transcatheter aortic valve replacement (TAVR) has emerged as a valid treatment option in symptomatic patients with failed aortic bioprosthetic valves, most especially in those with intermediate, high or prohibitive risk of surgery. Due to the unique design of stentless bioprosthetic valves with absence of visible posts and stent frame, they present with challenges during ViV TAVR procedure. Our case series assessed the safety, feasibility, and early outcomes of ViV TAVR in patients with failed bioprosthetic aortic valve replacement (AVR) using self‐expanding valve platform (Acurate Neo 2/AN2 valve) between March and September 2024 with minimalist approach. Procedural success, complications and early outcomes (mortality and functional status) were evaluated. A total number of three patients, mean age 75 ± 7 years, 67% female were included in the case series with high Society of Thoracic Surgeons (STS) and European System of Cardiac Operative Risk Evaluation II (EuroSCORE II) score. The mean time from initial surgery to ViV procedure was 18 ± 1 years. ViV procedure was successfully completed in all patients with no major complication, and no more than trivial trans/paravalvular regurgitation on discharge. There was no requirement for permanent pacemaker implantation, no stroke or mortality at 30‐day and there was significant improvement in functional class alongside symptomatic improvement. We report our experience in ViV TAVR using AN2 valve in Shelhigh supra stentless aortic bioprosthesis and that this procedure despite anatomical and procedural challenges is feasible and safe.