21 May 2026
TAV-in-SAV TAVI procedure - LIVE case
Lifetime management of severe aortic stenosis
Summary
A 70‑year‑old man with COPD and a history of severe aortic stenosis treated with SAVR (27 mm Perimount Magna) in 2012, followed by endocarditis in 2013, presented with symptomatic degeneration of the surgical valve, predominantly as severe aortic regurgitation. Left ventricular function was preserved (LVEF 50%) with a dilated left ventricle (7 cm).
A valve‑in‑valve TAVI procedure was performed using a 26 mm Sapien Ultra Resilia valve (+2 cc), via a single access. A double TAP (two‑step delivery) technique was used under local anesthesia.
LIVE Educational Case from Cleveland Clinic - London, UK
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Key moments
- 28:29-32:18 - Femoral access
- 33:43-38:10 - SAVR crossing
- 41:45-48:00 - Valve deployment
- 55:40-1:01:05 - Femoral access closure
- 1:09:03-1:14:10 - Procedural analysis
Keywords: Valve in valve, Sapien ultra resilia, femoral echo guided puncture, femoral access closure
Learning Objectives
- To discuss the lifetime management of severe aortic stenosis in patients with severe aortic stenosis
- To learn a steps involved in performing an optimal TAV-in-SAV procedure
- To review valve selection and procedure performance options in patients with degenerate surgical bioprosthesis
