In patients unsuitable for transfemoral transcatheter aortic valve implantation (TF-TAVI) due to peripheral artery disease, another route such as trans-subclavian-axillary or transcarotid is a becoming alternative. The novel Myval transcatheter heart valve system technology is a second-generation balloon-expandable valve described by design innovations that promote accurate positioning of the valve and warrant accurate orthotopic valve deployment. To our knowledge, this is the first case report in the literature of successful transcarotid TAVI via the novel balloon-expandable Myval THV system under the local anesthesia for heavily calcific and stenotic abdominal aorta and subclavian arteries.

In recent years, the use of bioprosthetic valve (BPV) has increased significantly with both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) due to reasons such as the advantage of not using anticoagulants. Nevertheless major disadvantage of all BPV is the risk of early structural valve deterioration, leading to valve dysfunction, and requires reoperation, which significantly increases the risk of mortality or major morbidity especially after SAVR. There are a limited number of TAV-in-TAV case reports due to TAVI BPV degeneration. In our knowledge this is the second report of TAV-in-TAV implantation wherein a previously implanted transfemoral 25-mm nonmetallic Direct Flow SVD valve treated with ViV TAVI via Edwards Sapien XT.