Implantation of two self-expanding aortic bioprosthetic valves during the same procedure-Insights into valve-in-valve implantation ("Russian doll concept").

Transcatheter aortic valve implantation has gained acceptance as a treatment for elderly patients considered high risk for surgical aortic valve replacement. There are still, however, many unresolved clinical and technical issues. The occurrence of transcatheter aortic valve-in-valve implantation has been reported anecdotally. Aside from a single case report, there is little literature on this topic. This study was conducted to evaluate the procedural, imaging, and clinical outcomes of patients who underwent transcatheter valve-in-valve implantation with two self-expanding aortic valve bioprostheses during the same procedure. We discuss also the potential valve of on-line quantitative angiography for assessing the depth of valve implantation and the need to implant a second valve. (c) 2009 Wiley-Liss, Inc.