A man with severe rheumatic trivalvular disease was treated with surgical implantation of mechanical aortic and mitral prostheses at the age of 30 years and tricuspid bioprosthesis at the age of 50 years. At 61 years of age, he developed severe symptomatic tricuspid regurgitation due to bioprosthesis degeneration and was judged at very high risk for a third surgical approach. The investigators describe the successful transfemoral positioning of a 29-mm Edwards SAPIEN XT percutaneous valve inside the degenerated tricuspid prosthesis, with excellent acute results and no major complications. In conclusion, percutaneous valve-in-valve treatment of degenerated bioprostheses is feasible by the transfemoral route and may be of assistance in very selected patients at high surgical risk. (c) 2013 Elsevier Inc. All rights reserved.
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