Successful catheter-based valve-in-valve implantation for a regurgitant stentless bioprosthesis.

Catheter-based transapical aortic valve implantation (TA-AVI) in patients with severe stenosis of the aortic valve and with a high operative risk is a new procedure which is becoming established in clinical practice. Aortic regurgitation is not yet a recognized indication for TA-AVI, and to date valve-in-valve (V-in-V) implantation in patients with incompetent stentless bioprostheses has not been attempted. The case is reported of a successful TA-AVI in a regurgitant, uncalcified stentless Medtronic Freestyle bioprosthesis. The position and hemodynamic function of the apically implanted valve were excellent, and the patient's current state of health is good.