79-year-old male presents with progressive dyspnea NYHA class III over the last 6 months. Past medical history of severe AS s/p TAVR with 29 Evolut Fx+(4/2025), CAD post CABGx3 (2010), hypertension, dyslipidemia, prostatic Ca on treatment, and OSA. A recent TEE showed bioprosthetic valve dysfunction with severe paravalvular AR (9-11 o’ clock position), minimal transvalvular AR and no aortic stenosis with declining LVEF 61% to 45%. Patient was evaluated by the Heart Team and was deemed extreme risk for SAVR in view of age and co-morbidities. CTA showed a well expanded but deeply implanted Evolut bioprosthesis with inflow dimension of 26.3*28.8(Avg 27.6mm), inflow area of 595.7 mm2, perimeter of 27.5mm with low risk of coronary obstruction (CRP above Neoskirt plane). Hence, the patient is now planned for a valve in valve TAVR with a 26mm Sapien-3U Resilia valve via right transfemoral approach.
