A complex case of TAV-in-TAV to salvage a suboptimal index TAVI procedure – anatomy is key

In this interesting chapter we see a highly novel application of TAV-in-TAV to salvage a sub optimal index TAVI procedural outcome, specifically related to paravalvular leak and a severely dilated and failing left ventricle. We will see the value of meticulous pre-procedural planning, specifically with regards to the second TAVI prosthesis in terms of sizing and positioning. Multiple challenges are overcome in this complex case, including limited arterial access sites, borderline transfemoral anatomy, as well as precise second TAVI prosthesis positioning to treat PVL. All is completed safely and effectively by utilising a step wise approach to the potentially catastrophic complication of annular injury.