Late Degeneration of a Transcatheter Aortic Valve Replacement Presenting With Flail Leaflet
© 2026 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of the Journal of Invasive Cardiology or HMP Global, their employees, and affiliates.
J INVASIVE CARDIOL 2026. doi:10.25270/jic/26.00064. Epub March 6, 2026.
An 80-year-old man presented with dyspnea. Nine years earlier, he had undergone transcatheter aortic valve replacement (TAVR) with a 29-mm Evolut R self-expanding valve (Medtronic) following aborted surgical aortic valve replacement due to extensive ascending aortic calcification.
Transesophageal echocardiography (TEE) revealed flail of the TAVR leaflet corresponding to the left cusp overhanging the left ventricular outflow tract, resulting in severe valvular aortic regurgitation (AR) (Figure A, Video). Computed tomography (CT) analysis showed that redo-TAVR appeared feasible with a 23-mm (+2 mL) SAPIEN 3 Ultra RESILIA valve (Edwards Lifesciences), aiming for outflow at Node 5.5 to Node 6 (Figure B and C).
Transfemoral redo-TAVR was successfully performed using the SAPIEN valve; it was implanted outflow at Node 6, pinning the flail leaflet to the aortic wall, and resulted in immediate resolution of AR and excellent hemodynamics (Figure D and E, Video).
Redo-TAVR for a degenerated TAV is increasingly performed. Degeneration usually presents with leaflet calcification and stenosis. This is the second case reported (the first by Vila-García J et al1) of severe AR due to a flail leaflet, underscoring the importance of close clinical follow-up and multimodality imaging.
Affiliations and Disclosures
Leila Alizadeh, MD1; Maria Eleni Drosou, MD1; Takayuki Onishi, MD1; Roya Anahita Mousavi, MD1; Amit Hooda, MD1; Sahil Khera, MD, MPH1; Lucy M. Safi, DO1; George D. Dangas, MD, PhD1; Gilbert H.L. Tang, MD, MSc, MBA2; Samin K. Sharma, MD1; Annapoorna S. Kini, MD1; Stamatios Lerakis, MD, PhD1
From the 1Department of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York; 2Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York.
Disclosures: Dr Khera has served as a consultant and proctor for Medtronic, Abbott Structural Heart, and W.L. Gore & Associates; a consultant for Terumo; a consultant and advisory board member of East End Medical; and serves on the speaker’s bureau for Zoll Medical and Edwards Lifesciences. Dr Safi has received speaker honoraria from Medtronic Structural Heart and has received speaker honoraria and served as a physician proctor for Abbott. Dr Tang has received speaker honoraria and served as a physician proctor, consultant, advisory board member, transcatheter aortic valve replacement publications committee member, APOLLO (Transcatheter Mitral Valve Replacement With the Medtronic Intrepid TMVR System in Patients With Severe Symptomatic Mitral Regurgitation) trial screening committee member, and IMPACT MR steering committee member for Medtronic; has received speaker honoraria and served as a physician proctor, consultant, advisory board member, ENVISION trial screening committee member, and TRILUMINATE (Trial to Evaluate Treatment With Abbott Transcatheter Clip Repair System in Patients with Moderate or Greater Tricuspid Regurgitation) anatomical eligibility and publications committee member for Abbott Structural Heart; has served as an advisory board member for Boston Scientific; and has served as a consultant for Philips, Anteris Technologies, Edwards Lifesciences, Shockwave Medical, Peijia Medical, and Shenqi Medical Technology. The remaining authors report no financial relationships or conflicts of interest regarding the content herein.
Consent statement: The authors confirm that informed consent was obtained from the patient for the intervention described in the manuscript and for the publication of their data/thereof, including any and all images.
Address for correspondence: Stamatios Lerakis, MD, PhD, Mount Sinai Fuster Hear Hospital, 1 Gustave L. Levy Place, New York, NY 10029, USA. Email: stamatios.lerakis@mountsinai.org; X: @LeilaAlizadehMD, @RoyaMousavi_MD, @GilbertTangMD, @LucySafi, KHERA_MD, @SaminKSharma, @AmithoodaMD
References
- Vila-García J, De La Osa Hernández G, Iniesta Manjavacas ÁM, et al. A torn leaflet: an unusual complication of a degenerated transcatheter aortic valve prosthesis. JACC Cardiovasc Interv. 2025;18(8):1062-1064. doi:10.1016/j.jcin.2024.11.024
