Intentional bioprosthetic tricuspid valve fracture to facilitate transcatheter valve‐in‐valve deployment

Abstract

While transcatheter valve‐in‐valve (ViV) implantation may reduce the number of lifetime surgical reinterventions in some patients with congenital heart disease, in other patients the bioprosthetic valve ring can lead to patient‐prosthesis mismatch due to reduction of internal diameter if a transcatheter valve is implanted. A 49‐year‐old woman with multiple prior cardiac surgeries presented with heart failure due to bioprosthetic tricuspid valve stenosis. Initial predilation valvuloplasty suggested conventional ViV implant would produce patient‐prosthesis mismatch, therefore, we intentionally fractured the bioprosthetic valve ring to facilitate optimal hemodynamics with implantation of a 29 mm transcatheter valve.