SAFE AND EFFECTIVE REDO–TAVR WITH EDWARDS SAPIEN 3 IN A DEGENERATED ACURATE NEO2 VALVE: A CASE REPORT

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Abstract This case report highlights the successful management of severe aortic insufficiency caused by bioprosthetic valve dysfunction in an 86–year–old male with a history of comorbidities, including arterial hypertension, dyslipidemia, type 2 diabetes, and chronic kidney disease. The patient previously underwent TAVI with an ACURATE neo2 valve (27 mm) for severe aortic stenosis in 2019. Patient was admitted to our hospital for evidence of Structural valve deterioration (SVD) for a severe aortic regurgitation. Following a comprehensive preprocedural evaluation, including echocardiography and CT analysis, a redo–TAVR was performed using a balloon–expandable Edwards SAPIEN 3 valve (26 mm). The procedure emphasized a low implantation strategy, aligning the risk plane with the upper crown to reduce coronary obstruction risk and enable facilitated coronary access. An additional safety measure involved positioning a balloon in the left main coronary artery during deployment. Post–procedural outcomes, including angiography and transthoracic echocardiography, confirmed the safety and efficacy of the intervention. The ACURATE neo2 design minimized sinus sequestration risk and allowed valve implantation without coronary stenting. This case underscores the potential of SAPIEN–in–ACURATE procedures to address complex redo–TAVR scenarios. Further real–world data are needed to validate these findings and optimize clinical strategies.Figure 1:CT analyses of coronary height respect the new annulus of Accurate valve Figure 2:Final position of Sapien valve before the deployment: Please note the coronary protection with guidewire and stent allocated in left descending artery. Figure 3:final angio that shows patency of left main without need for stent placement.

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