Navitor™ in Evolut™: a case report illustrating a novel approach to redo-transcatheter aortic valve implantation

Background: Transcatheter aortic valve implantation (TAVI) is expanding to younger patients, and the management of valve failure is a growing clinical problem. The transcatheter heart valve (THV) of choice for redo-TAVI is a complex decision, and first reports have examined the use of the Sapien 3™ THV (Edwards Lifesciences; Irvine, CA, USA) in failed Evolut™ (Medtronic, Minneapolis, MN, USA) THV. However, several different technical approaches may be worth consideration, and the subject remains a matter of debate.

Case summary: A 73-year-old female with previous coronary artery bypass grafting, percutaneous coronary intervention (PCI), and TAVI with a 26 mm Evolut™ R THV presented with signs of heart failure. The clinical investigation revealed a severe restenosis of the THV valve and a stenosis of the left coronary main stem. The patient was successfully treated with PCI of the left main and, during the same procedure, underwent implantation of a 25 mm Navitor™ THV (Abbott; Chicago, IL, USA).

Discussion: This case presentation aims to illustrate the rationale of and necessary conditions for performing a TAVI-in-TAVI procedure with Navitor™ THV in a failed Evolut™ THV which, to our best knowledge, constitutes a novel approach to redo-TAVI.