Work

Strategic Reintervention With Marked Oversizing and Overexpansion in TAV-in-SAV for Hemolytic Paravalvular Leak

Year: 2026

Type: article

Abstract: BACKGROUND: Paravalvular leak (PVL) is a common complication of surgical aortic valve replacement and may recur even after transcatheter plug closure. CASE SUMMARY: A 71-year-old man developed recurrent PVL with hemolytic anemia 4 years after plug closure after redo surgical aortic valve replacement with a 25-mm Carpentier-Edwards Perimount Magna Ease valve. Valve-in-valve transcatheter aortic valve replacement was performed using a 29-mm Sapien 3 Ultra Resilia valve (Edwards Lifesciences). To achieve sufficient oversizing and annular apposition, a deliberately oversized valve was selected and deployed using balloon overfilling. DISCUSSION: We report the intentional use of an oversized Sapien 3 valve with deliberate overexpansion beyond the standard size recommended for a 25-mm Magna Ease valve. This strategy led to effective PVL sealing and the complete resolution of hemolysis. TAKE-HOME MESSAGES: Anatomy-guided valve oversizing, combined with intentional overexpansion, is pivotal to procedural success. This approach may be a viable treatment option for high-risk patients with recurrent PVL.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2026.106869