Aortic valve replacement and mitral valve repair as treatment of complications after percutaneous core valve implantation.

CLINICAL SUMMARY We describe the case of a 66-year-old man who had surgical intervention for a core valve malfunction 3 months after transfemoral implantation. The patient was scheduled for percutaneous aortic valve implantation (PAVI) because of the presence of numerous risk factors, such as obesity (body mass index, 35%) and myelodysplasia. The main concern about elective standard aortic valve replacement was related to the patient’s pulmonary function. As a result of a history of smoking and obesity, he had severe chronic pulmonary disease (forced expiratory volume in 1 second, <35%) and obstructive sleep apnea syndrome requiring noninvasive mechanical ventilation. The patient presented with rapid worsening of dyspnea. An echocardiogram showed a severely calcified aortic stenosis with left ventricular hypertrophy and good ejection fraction (60%). For this reason, he was evaluated for aortic valve replacement. Preoperative coronary angiographic analysis revealed normal coronary arteries. Despite a relative low EuroSCORE, PAVI was indicated because of multiple comorbidities and requested by the patient. PAVI with a core valve bioprosthesis was performed without procedural complications. Only a second balloon dilatation was required for a moderate paraprosthetic aortic regurgitation detected immediately after the procedure, and a mild-to-moderate paraprosthetic aortic regurgitation re-