Successful Aortic Valve Replacement After Transcatheter Aortic Valve Implantation (TAVI) Following Initial Surgical Aortic Valve Replacement (SAVR): A Case Report.

Abstract

BACKGROUND The management of degenerated bioprosthetic aortic valves poses a significant clinical challenge, particularly in younger patients with a history of rheumatic heart disease. While transcatheter aortic valve replacement (TAVR) has emerged as a less invasive alternative to redo surgical aortic valve replacement (SAVR), its long-term durability and the potential need for subsequent interventions remain areas of concern. This report describes a unique case of a young patient who underwent SAVR after TAVR, following an initial SAVR, highlighting the complexities and therapeutic considerations in managing such cases. CASE REPORT A 39-year-old woman with a history of rheumatic heart disease and severe aortic stenosis underwent bioprosthetic aortic valve replacement in 2014. She subsequently required TAVR in 2023 due to valve degeneration. Despite TAVR, she developed recurrent severe aortic stenosis, necessitating a redo SAVR with a mechanical valve in 2024. This report outlines the patient's clinical course, diagnostic findings, and surgical management. CONCLUSIONS This case underscores the importance of careful patient selection and long-term follow-up in individuals undergoing aortic valve interventions. It highlights the potential need for subsequent surgical intervention even after TAVR, particularly in younger patients. The successful redo SAVR following TAVR demonstrates the feasibility of this approach in carefully selected cases, despite increased surgical complexity.