Evolut R implantation in Perceval bioprosthesis with periprosthetic leakage. Case resolution

Case Resolution With an 8.5% score in the Society of Thoracic Surgeons risk score for mortality rate, we decided to implant one Evolut PRO transfemoral bioprostheis on an underexpanded bioprosthesis. The computed tomography confirmed the lack of coverage of the bioprosthetic stent over the aortic annulus at the level of the Valsava, non-coronary and right coronary sinuses (figure 1), indicative of stent recoil of the stent harboring the bioprosthetic leaflets as the possible mechanism of periprosthetic failure and causing malapposition with the aortic annulus. The perimeter of the aortic annulus was 79.3 mm (minimum diameter: 22 mm; maximum diameter: 25 mm). Figure 1. Lack of coverage of the bioprosthetic stent over the aortic annulus at the level of the Valsava, non-coronary and right coronary sinuses (asterisk). The colored dots are indicative of the location of coronary sinuses. One self-expandable prosthesis was selected with leaflets at the supra-annular level, since it has already been confirmed that in valve-in-valve procedures, the hemodynamic outcome is better compared to the annular implantation that leaves a more significant trans-prosthetic gradient. Also, the position of the prosthesis inside the prosthesis needs to be optimal, which makes the Evolut R the perfect device for this kind of procedure for its...