Clinical Research in Cardiology

, Volume 108, Issue 10, pp 1069–1073 | Cite as

Two birds with one stone: transcatheter valve-in-valve treatment of a failed surgical bioprosthesis with concomitant severe stenosis and paravalvular leak

  • Hector A. Alvarez-Covarrubias
  • Erion Xhepa
  • Jonathan M. Michel
  • A. Markus KaselEmail author
Critical Perspective


Implantation of bioprosthetic surgical valves has been a common procedure in elderly patients with severe aortic stenosis due to patients´ preferences avoiding anticoagulation therapy. However, this valve presents sometime certain deterioration degree (i.e., dysfunction due to stenosis or regurgitation) or even paravalvular leak. Transcatheter heart valve implantation is a good alternative in high-risk patients. The valve-in-valve procedure has been shown to be a safe and effective procedure. However, the presence of the fixed sewing ring of the surgical bioprosthesis can hamper appropriate expansion of the THV. For this reason, the use of cracking balloon seems to be a safe alternative to increase the effective orifice area. We present a case of a patient with a degenerated previous implanted biological valve and paravalvular leak. We used the treatment strategy of valve-in-valve with post-dilatation with high-pressure balloon, in a way to treat both, the degenerated valve and the paravalvular leak. The use of a single percutaneous procedure was enough and safe to treat both problems without further complications.

Graphic abstract


TAVI TAVR Fracturing Cracking Paravalvular leak Valve-in-valve 




Compliance with ethical standards

Conflict of interest

A. M. Kasel is proctor and consultant for Edwards Lifesciences. The other authors have no conflicts of interest to declare.

Supplementary material

392_2019_1519_MOESM1_ESM.mp4 (24.2 mb)
Supplementary material 1 (MP4 24804 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hector A. Alvarez-Covarrubias
    • 1
    • 2
  • Erion Xhepa
    • 1
  • Jonathan M. Michel
    • 1
  • A. Markus Kasel
    • 1
    Email author
  1. 1.Cardiology DepartmentGerman Heart Center Munich, Technical University MunichMunichGermany
  2. 2.Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSSMexico CityMexico

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