1. • What is going on here?
• Why are there two
valves?
• Where are the two
valves?
89 Year Old Female 1 Year Post TAVR

2. • 88 yo female with
severe, symptomatic AS,
STS 7.9
• CTA annulus 21.4 x 25.8,
perimeter 75.3 mm
• RFA cutdown,
BAV 20x5 balloon,
29 mm Corevalve
• Valve deployed to 2/3
position with severe
PVL
What to do next?
89 Year Old Female 1 Year Post TAVR

3. • Low implant with PVL
around valve skirt
• Attempted pull back
with “pop-out” of valve
• Valve pulled into
descending aorta but
unable to reach sheath,
so deployed in thoracic
aorta
89 Year Old Female 1 Year Post TAVR

4. • 2nd valve deployed with
mild PVL
• One year later patient
with trace AR, and no
obstruction from 1st valve
Take Home Points:
• Severe PVL needs to be
treated
• Valve in Valve acceptable
• Can pull back Corevalve
but need to be prepared
for “pop-out” with 2nd
valve
89 Year Old Female 1 Year Post TAVR