TAVI updates: complex valve-in-valve cases

Case Example:

A 71-year-old gentleman had a history of bioprosthetic surgical aortic valve and CABG 12 years prior, presented with NYHA class IV heart failure symptoms. Transthoracic echocardiogram revealed severe left ventricular dysfunction with severe intravalvular aortic regurgitation. Transoesophageal echocardiography (TOE) demonstrated the mechanism of severe aortic regurgitation as degenerative prolapse of the bioprosthetic aortic valve leaflet (Image 1).