First Case of Late Onset Valve Dislocation after Aortic Valve Replacement with the Edwards Intuity Elite Rapid-Deployment Bioprosthesis

Introduction: Over the last decade, aortic valve replacement with rapid-deployment biological bioprosthesis has become a common alternative technique to mechanical or biological stented valves for high-risk patients. The clinical evidence on this new prosthesis is growing constantly and reports about delayed valve dislocation are rare. With this case, we report the first case of valve migration for the Edwards Intuity Elite rapid-deployment aortic valve.

Methods: In June 2017, a 63 year old patient with severe aortic stenosis and concomitant coronary three vessel disease underwent an uncomplicated valve replacement with the Edwards Intuity Elite Valve (size: 23 mm) and coronary artery bypass graft. The patient was discharged into rehabilitation treatment 8 days after surgery. Echocardiographically, the valve function was excellent without signs of paravalvular regurgitation or dislocation. 2 months after the operation, the patient had progredient dyspnea NYHA III. Echocardiography showed a dislocation of the aortic valve into the left ventricular outflow tract (LVOT). Movement of the anterior mitral valve leaflet was impaired by the valve stent resulting in severe mitral valve insufficiency. The indication for re-operation was set. The right coronary guiding suture was loosened so that the valve could migrate downwards. As the Intuity Valve cannot be reused, it was replaced by a conventional stented bioprosthesis (Edwards Magna Ease Aortic), sized 23 mm and because the mitral valve anatomy could not be restored, the valve was also replaced (Edwards Magna Mitral Ease, 31 mm). Intraoperative transesophageal and postoperative transthoracic echocardiography showed a correct position and normal function of the bioprostheses without paravalvular leakage. The postoperative course was uneventful.

Conclusion: Valve replacement with rapid-deployment bioprosthesis is considered to be effectively and safe. We report the first case of a late onset valve dislocation of the Edwards Intuity Elite Valve. This complication may be rare but severe, as it requires reoperation.