Transapical off-pump aortic valve-in-a-valve implantation in two elderly patients with a degenerated porcine bioprosthesis.

Re-operative heart-valve replacement is a high-risk procedure and even more so in elderly patients. Another option in high-risk patients with a degenerated aortic xenograft is the implant of a second aortic bioprosthesis using a transcatheter approach. We report two cases of patients with a severely degenerated porcine aortic bioprosthesis who were successfully treated by a transapical valve-in-a-valve implantation. Copyright (c) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.