Early Structural Deterioration of a Self-Expanding Transcatheter Aortic Valve Prosthesis Presenting With Severe Aortic Insufficiency: A Case Report

TL;DR

An 88-year-old man experienced early failure of a self-expanding heart valve five years after implantation, leading to severe aortic insufficiency and requiring surgical replacement.

Contribution

This case report documents a rare instance of rapid structural deterioration of a self-expanding transcatheter aortic valve within five years.

Findings

A 34 mm Evolut valve failed within five years, causing severe aortic insufficiency.

The patient required surgical replacement with an Inspiris Resilia bioprosthesis.

The case highlights the importance of physical examination in detecting early valve degeneration.

Abstract

Transcatheter aortic valve replacement has become an established therapy for severe aortic stenosis, demonstrating prosthesis durability for at least five years (and up to eight years) in recent studies. Structural valve deterioration within 5 years is rare, particularly with self-expanding Evolut prostheses. We present an 88-year-old man with prior coronary artery bypass grafting and severe aortic stenosis who underwent transfemoral transcatheter aortic valve replacement with a 34 mm Evolut valve in 2019. Five years later, he developed progressive dyspnea and chest pain. Examination revealed a grade IV/VI decrescendo diastolic murmur and a markedly wide pulse pressure, raising concern for severe aortic regurgitation. Transesophageal echocardiography demonstrated moderate to severe aortic insufficiency. Coronary angiography revealed patent grafts, without new obstructive native coronary disease. He underwent surgical aortic valve replacement with an Inspiris Resilia bioprosthesis. This case underscores the possibility of rapid prosthetic valve failure and highlights the ongoing importance of physical examination in detecting severe regurgitation. It also contributes to the growing literature on early valve degeneration.

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