Trans-catheter aortic valve-in-valve implantation in an elderly patient with Evans syndrome.

We report the first case of trans-catheter aortic valve implantation in a 90-year-old man with a severely stenotic bioprosthetic aortic valve in the context of an autoimmune hemolytic anemia and immune thrombocytopenia (Evans syndrome) using the trans-femoral approach. The patient was supported in the peri-procedural period with high-dose steroids, intravenous immunoglobulins, platelet transfusions, and thrombopoietin receptor agonist (romiplostim). The post-procedural period was unremarkable with no bleeding complications. <Learning objective: Trans-catheter aortic valve implantation has become a treatment option for severe aortic stenosis in patients with high-risk features for surgical intervention. This includes patients with bleeding diathesis, who can undergo trans-catheter aortic valve replacement with minimal incidence of vascular and bleeding complications with careful peri-procedural planning using current standard of care approaches.>.