JACC Case Reports · Nov 2026
Staged Transcatheter Valve-in-Valve Replacement for Simultaneous Failure of 3 Surgical Bioprosthetic Valves
By del Castillo DV, Wang Y
Objectives To describe a heart team-driven staged transcatheter strategy for accelerated triple bioprosthetic valve failure in a patient with prohibitive surgical risk. Key Steps A 78-year-old woman with systemic lupus erythematosus, stage 4 chronic kidney disease, permanent atrial fibrillation, and severe frailty presented with NYHA functional class III heart failure. She had undergone triple surgical bioprosthetic heart valve replacement 8 years earlier. Imaging demonstrated severe aortic, mitral, and tricuspid bioprosthetic valve failure. Given prohibitive surgical risk, a staged transcatheter strategy was selected. Valve-in-valve transcatheter aortic valve replacement with a 23-mm supra-annular self-expanding valve and bioprosthetic valve fracture was performed first, followed by valve-in-valve (ViV)–transcatheter mitral valve replacement and ViV transcatheter tricuspid valve replacement with 26-mm balloon-expandable valves. All procedures were successful without complications. At 2 months, NYHA functional class improved from III to II, with satisfactory function of all 3 valves. Potential Pitfalls Coronary obstruction, patient-prosthesis mismatch, neo–left ventricular outflow tract obstruction, and hemodynamic intolerance. Take-Home Messages Staged triple ViV intervention may provide a feasible alternative to redo surgery. Multimodality imaging and individualized sequencing are critical.