Transcatheter 'Sandwich' Valve-in-Valve Implantation Technique for Pure Aortic Regurgitation: Operation Skills and Early Experience

No commercial “on-label” transfemoral transcatheter aortic valve replacement (TAVR) device for aortic regurgitation (AR) is available in most countries. TAVR for AR with an “off-label” self-expanding device has shown acceptable procedural success but it elevated rates of early mortality and other complications. Valve disposition or displacement frequently occurs during transfemoral TAVR (TF-TAVR) for AR with a self-expanding valve, because of weak anchoring force. To overcome this problem, we propose a transcatheter “sandwich” valve-in-valve implantation (SVIV) technique, which has achieved good results. Our initial results and experience in a case series comprising seven patients suggest that the SVIV technique using commercially available self-expanding valves may be an option for treating selected patients with AR with high risk for surgical valve replacement. Compared with the traditional method, this technique can decrease the incidence of complications, particularly conduction block, but several technical details require the operator’s attention. Additional research is required to confirm the superiority of this technology.