An 88-year-old female with severe aortic stenosis underwent TAVR with a 29mm CoreValve which was implanted too low, resulting in severe paravalvular leak. Attempts to reposition the valve caused it to dislodge into the descending aorta where it could not be recaptured. A second 29mm CoreValve was implanted successfully with only mild leak. At one year follow up, the patient had trace aortic regurgitation and no obstruction from the first misplaced valve.

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