Redo multiple valve replacement is known to carry additional risk of morbidity and mortality. Currently, a transcatheter-based valve-in-valve approach could be useful in reducing potential serious consequences. On the other hand, this approach poses several technical challenges regarding the device and procedural aspects of the procedure. We present the case of a 78-year-old man who presented with symptoms of heart failure due to mitro-aortic bioprosthesis degenerations who was deemed to be at extremely high risk for conventional redo surgery. A two-steps single admission transcatheter-based approach was planned with a transfemoral aortic valve-in-valve procedure followed by a trans-apical mitral valve-in-valve implantation. The outcome was good and the recovery was fast.
Iatrogenic acute aortic dissection during percutaneous coronary intervention is an extremely rare but potentially life-threatening complication occurring in less than < 0,02% of the procedures. We report the cases of 3 patients with aortic dissection during percutaneous coronary intervention successfully treated with an emergent ascending aorta replacement. The main goal is the closing of the intimal tear as fast as possible damage either with a percutaneous system (i.e. a proximal stent) or with an open heart open surgery to prevent the extension of the dissection and neurological. A conservative strategy should be pursuit only in small localized sinus dissections.