The first transapical transcatheter aortic valve-in-valve implantation using the J-valve system into a failed biophysio aortic prosthesis in a patient with high risk of coronary obstruction.

We report the first successful valve-in-valve (ViV) implantation into a failed Edwards Biophysio surgical prosthesis (Edwards Lifesciences, Irvine, CA) and also the first use of the J-Valve system (Jie Cheng Medical Technologies, Suzhou, China) in a ViV configuration. A 77-year old male had symptomatic severe aortic stenosis secondary to failure of a 25 mm Biophysio bioprosthetic valve implanted 11 years previously, along with concomitant coronary artery bypass grafting. Transthoracic echocardiography (TTE) revealed calcified leaflets, a mean aortic gradient of 50 mm Hg, and an estimated valve area of 0.9 cm with no aortic insufficiency. The patient had low coronary ostial height with the right coronary artery arising only 8.5 mm from the valve annulus and the left main coronary artery arising only 9.4 mm from the valve annulus. Risk of coronary ostial obstruction was especially concerning in context of both the patient's extremely low coronary ostial height and the unique structure of the Biophysio valve. Under general anesthesia, transapical transcatheter aortic ViV implantation with a 25 mm J-Valve was performed in a hybrid operating room. The J-Valve prosthesis was deployed in the 25 mm Biophysio surgical valve without difficulty or complications. There were no intraoperative or postoperative complications. The patient was discharged home after 3 days. TTE at 1 year showed a mean aortic valve gradient of 14 mm Hg, and no aortic insufficiency. This case demonstrated that J-Valve implantation may be a new option for patients at high risk for coronary obstruction.