Case and Plan:

61-year-old female with bioBentall procedure with 23 mm Magna for severe aortic insufficiency with ascending aortic aneurysm 10 years ago. Now presents with shortness of breath, leg edema and multiple comorbidities of MTHFR mutation, recurrent thrombosis, s/p ileostomy for diverticulitis and severe COPD. TTE/TEE shows LVEF 40% with structural valve deterioration (PV/PG/MG:4.2/70/44) with minimal transvalvular regurgitation. STS risk mortality for redo AVR is 4.11%. The heart team found the patient at high risk for redo surgical AVR because of comorbidities. Based on her young age and from the viewpoint of her lifetime management, she is planned to undergo valve-in-valve TAVR using 23 mm SAPIEN-3 Ultra Resilia for failed 23mm Magna via right percutaneous femoral arterial access and possible sentinel device.

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