Valve-in-Valve Implantation of a Sapien 3 Transcatheter Heart Valve for Reduction of Paravalvular Regurgitation Despite Optimal Placement of the First Transcatheter Heart Valve.

Valve-in-valve implantation is generally successful in reducing paravalvular regurgitation (PVR) in cases in which the first transcatheter heart valve is deployed in a suboptimal location. We describe a case of severe PVR 2 months after implantation of a 26-mm Sapien XT valve (Edwards Lifesciences Inc, Irvine, CA) in the optimal location. Valve-in-valve implantation of a Sapien 3 valve (Edwards Lifesciences Inc), and enough left ventricular outflow tract tissue at the inflow edge the Sapien XT to appose the sealing cuff of the Sapien 3 combined for successful PVR treatment. To our knowledge, this is the first case of PVR reduction with valve-in-valve despite the original valve being appropriately sized and placed.