First valve severe malposition as a reason for redo TAV-in-TAV implantation

81-year old patient with symptomatic aortic stenosis was admitted to hospital for transfemoral TAVI procedure. The Evolut 34 valve was implanted, but due to difficult implantation there was severe malposition of the valve causing moderate, but clinically asymptomatic PVL. The patients was observed for 4 months until severe hemodynamic deterioration occurred. TAV-in-TAV procedure using Edwards S3 29 was performed. There was trace PVL after implantation, and in the 6 months follow up EF has improved and patient was asymptomatic.