ArticleJACC. Case reports2026
Valve-in-Valve TAVR for Degenerated Perceval Valves: From Entrapment to Success.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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6 authors.
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Abstract
backgroundValve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is an established treatment option for bioprosthetic valve failure. The sutureless Perceval bioprosthesis presents unique technical challenges because of the valve's supra-annular nitinol ring, lack of radiopaque markers, and potential difficulty with central valve crossing and entrapment of devices within the supra-annular ring. CASE SUMMARY: We report 2 cases of Perceval degeneration managed with ViV-TAVR using balloon-expandable Edwards Sapien 3 Ultra valves. In the first case, standard retrograde crossing led to delivery system entrapment despite multiple conventional methods for assessing central crossing, requiring multiple complex bailout maneuvers including balloon-assisted displacement and TAVR delivery system snaring. In the second case, after failed central retrograde crossing, antegrade transseptal approach with arteriovenous loop formation enabled precise central crossing. After wire externalization via the femoral artery, standard retrograde TAVR delivery and successful valve deployment were performed without complication. Both patients experienced favorable outcome and symptom resolution at follow-up. TAKE-HOME MESSAGES: These cases highlight the importance of preprocedural planning, advanced imaging guidance, and alternative access and crossing strategies when performing ViV-TAVR in Perceval valves. The antegrade approach may be safer, is reproducible, and saves on procedure time.
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