Transcatheter aortic valve replacement for aortic regurgitation following valve sparing root replacement: a case series

Background Valve sparing aortic root replacement (VSARR) is a treatment for aortic root dilatation and aortic regurgitation (AR), which preserves the aortic valve. However, AR may recur, and redo surgery often carries high risk. Transcatheter aortic valve replacement (TAVR) can be performed but there is a paucity of literature to guide procedural planning.Case summary Two cases are presented herein with recurrence of severe AR following VSARR (David procedure). In both cases, computed tomography (CT) scans demonstrated absence of calcium and a narrow sinus of valsalva. Both cases were considered at prohibitive risk for redo surgery and were successfully treated with TAVR using balloon-expandable valves. The valves were sized based on CT (aiming for moderate oversizing of 10%-11%) and by assessing the anchoring and waist of sizing balloons. Post-procedure aortography and echocardiography revealed no transvalvular or paravalvular regurgitation. Both patients were successfully discharged with follow-up CT scans also showing no migration and preservation of coronary access, together with suitability of future redo TAVR if required.Discussion TAVR can be successfully performed after VSARR surgery with a balloon-expandable valve in the absence of aortic valve calcification. Moderate THV oversizing (10%-11%) appears safe and effective. Careful assessment with a sizing balloon is recommended to ensure adequate anchoring, without the need for aggressive oversizing which risks rupture at the graft suture line.