Background: Advanced heart failure has extremely high mortality without advanced
therapies (left ventricular assist device (LVAD) implantation or cardiac transplant). LVAD patients
with bioprosthetic aortic valve are more prone to leaflet fusion resulting in valvular stenosis and
Case Presentation: We present a 46-year-old patient who had LV systolic function recovery while
on LVAD. However, he had a severely stenotic aortic valve bioprosthesis with leaflet fusion that
had to be replaced before deactivating his LVAD. Due to high surgical risk, we performed valve-invalve
Trans-Catheter Aortic Valve Replacement (TAVR) with an Evolut self-expanding valve,
however, the patient had significant aortic regurgitation secondary to deployment above the bioprosthetic
valve ring. We successfully deployed a second Evolut Self-expanding valve inside the
ring with excellent results. This was followed by a successful LVAD deactivation next day. His LV
systolic function continued to recover and he had no heart failure symptoms at 3 month follow up.
In the right settings, TAVR in recovered LVAD patients with aortic stenosis as a bridge to LVAD
deactivation is a viable option, especially for patients who fall in the high-risk group.
Conclusion: To the best of our knowledge, this is the first reported case of a valve-in-valve TAVR
followed by successful LVAD deactivation in the setting of recovered LV systolic function.