Complex valve-in-valve leaflet modification - LIVE Case

Watch this LIVE case followed by a recorded case, regarding a 79-year-old male with permanent AF and a history of surgical aortic valve replacement in 2010 (Magna Ease 25) who presented with symptomatic bioprosthetic valve stenosis, normal LV function, and no CAD. A Sapien 3 Ultra 23 mm valve was implanted under general anesthesia. Valve preparation included a unicorn left cusp technique. During leaflet modification, a horizontal balloon rupture occurred, with some difficulty retrieving the balloon.

Recorded case: A 70-year-old patient with COPD and right bundle branch block presented with symptomatic aortic stenosis. An Octapro 30.5 valve was implanted under local anesthesia using a transcaval approach. Closure was achieved with an occluder device for the vena cava and a PercuQ closure system for the femoral access.

LIVE Educational Case from Clinique Pasteur - Toulouse, France

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Key moments

• 24:08–28:49 – Unicorn: setup and hole in the left cusp
• 29:07–53:34 – 14 mm balloon rupture, recapture and final
• 54:22–58:03 – Valve implantation in the hole of the left cusp
• 1:04:38–1:07:50 – Procedural analysis
• 1:17:57–1:28:53 – Valve implantation via transvena cava and percuQseal closure

Keywords: Sapien 3 Ultra, Octapro, Unicorn technique, transvena cava access, percuQseal closure