Avoiding Redo Open-Heart Surgery with Valve-in-Valve TAVR.
A 78-year-old with a failing bioprosthetic valve had a minimally invasive option she did not know existed.
This is a composite narrative based on common clinical scenarios. Patient details have been anonymized and combined for educational purposes. Individual results vary based on specific clinical circumstances.
A 78-year-old retired nurse from Georgia had her aortic valve replaced surgically 14 years ago with a bioprosthetic valve. She began experiencing worsening shortness of breath, and echocardiography showed the tissue valve was degenerating with severe stenosis. Her local surgeon recommended redo open-heart surgery — her second sternotomy — with an STS predicted mortality of 6.8%.
What our Heart Team found.
Our Heart Team review confirmed severe bioprosthetic valve degeneration requiring intervention. However, we identified that her valve size and CT imaging were favorable for valve-in-valve TAVR — implanting a new transcatheter valve inside the failing surgical valve. This approach would avoid redo sternotomy entirely, with an expected procedural mortality of less than 2% and a hospital stay of 2-3 days.
What happened next.
She underwent successful valve-in-valve TAVR and was discharged home after 2 days. Her symptoms resolved completely. At 6-month follow-up, her valve was functioning well with minimal gradients.
Valve-in-valve TAVR offers a minimally invasive alternative to redo open-heart surgery for patients with failing bioprosthetic valves. Not all patients are told about this option, and a Heart Team evaluation is essential.
