Acute presentation of structural valve degeneration in a transcatheter heart valve (Sapien XT) at 7.5 years; successful redo TAVR with a Sapien S3 Ultra.

Abstract Little is known about the presentation of structural valve degeneration complicating transcatheter heart valves. We report a case of acute heart failure, secondary to leaflet prolapse, in a previously well 77-year-old male, 7.5 years following successful TAVR with a 26mm balloon-expandable Sapien XT THV. This case highlights that SVD complicating THVs may lead to acute presentation with little warning from prior echocardiograms. Calcification may be absent on imaging. Redo TAVR is feasible and appears safe. Post deployment optimisation with a highly non-compliant balloon may improve full expansion of the newly implanted THV and improve valve performance.