Surgical Aortic Valve Replacement Following Transcatheter Aortic Valve Implantation Degeneration in a Patient with Prior David Procedure: A Case Report.

This is the first reported case of a self-expanding aortic valve explanted from the ascending aorta consisting of a Dacron prosthesis. We describe a 75-year-old male with bicuspid aortic valve regurgitation initially treated with a David procedure. Following degeneration, a "valve-in-repaired-valve" transcatheter aortic valve implantation (TAVI) was performed. Six years later, he presented with dyspnea, severe insufficiency, and paravalvular leakage. An interdisciplinary team opted for redo surgery. The patient underwent successful redo aortic valve replacement with an EpicMax bioprosthesis via resternotomy. Despite a complex postoperative course, he recovered well. This case underscores key challenges in lifetime management, including TAVI durability, sizing, and reoperative strategies.