{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T11:51:47Z","timestamp":1773229907742,"version":"3.50.1"},"reference-count":8,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,2,10]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>Given the diverse technical challenges associated with transcatheter valve-in-transcatheter valve procedures, the treatment strategy for each clinical case must be tailored to the individual patient.<\/jats:p>\n                  <jats:p>We present the case of a man in his late 70s with a complex clinical history, including two prior transcatheter aortic valve implantation (TAVI) procedures and infective endocarditis, who later developed severe degeneration of the aortic prosthesis requiring a third transcatheter intervention.<\/jats:p>\n                  <jats:p>Initially treated with a Lotus valve in 2014, the patient underwent a TAV-in-TAV with an Evolut prosthesis in 2022, followed by endocarditis-related degeneration and severe restenosis. In 2024, a third prosthetic valve (Acurate neo2) was implanted using the TAV-in-TAV-in-TAV technique.<\/jats:p>\n                  <jats:p>With expanding indications for TAVI and increasing longevity among treated patients, complex multi-prosthesis interventions may become more frequent, highlighting the need for improved procedural planning, imaging strategies and long-term surveillance. At 1-year follow-up, the patient remains asymptomatic with preserved valve function.<\/jats:p>\n                  <jats:p>This case illustrates the feasibility of a third TAVI after treated prosthetic valve endocarditis, supported by CT-guided procedural planning and 1-year follow-up, which remains scarcely reported in the literature.<\/jats:p>","DOI":"10.1136\/bcr-2025-269921","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T14:45:14Z","timestamp":1773153914000},"page":"e269921","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["TAV-in-TAV-in-TAV after treated endocarditis: procedural strategy, imaging planning and 1-year outcome"],"prefix":"10.1136","volume":"19","author":[{"given":"Evgeny Vladimirovich","family":"Merkulov","sequence":"first","affiliation":[{"name":"Endovascular Diagnostics and Treatment, FSBI Academician E I Chazov National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, Moscow, Moscow, Russian Federation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Goar Kimovna","family":"Arutyunyan","sequence":"additional","affiliation":[{"name":"Endovascular Diagnostics and Treatment, FSBI Academician E I Chazov National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, Moscow, Moscow, Russian Federation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrey Sergeevich","family":"Tereshchenko","sequence":"additional","affiliation":[{"name":"Endovascular Diagnostics and Treatment, FSBI Academician E I Chazov National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, Moscow, Moscow, Russian Federation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dmitriy V","family":"Pevzner","sequence":"additional","affiliation":[{"name":"Emergency Cardiology Department, FSBI Academician E I Chazov National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, Moscow, Moscow, Russian Federation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iiliya Tarasovich","family":"Zyuryaev","sequence":"additional","affiliation":[{"name":"Emergency Cardiology Department, FSBI Academician E I Chazov National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, Moscow, Moscow, Russian Federation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariya Alekseevna","family":"Terenicheva","sequence":"additional","affiliation":[{"name":"Emergency Cardiology Department, FSBI Academician E I Chazov National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation, Moscow, Moscow, Russian Federation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga Nickolaevna","family":"Ganeeva","sequence":"additional","affiliation":[{"name":"LLC \u00abCardiomedics\u00bb, Moscow, Russian Federation"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexey Vladimirovich","family":"Knigin","sequence":"additional","affiliation":[{"name":"LLC \u00abCardiomedics\u00bb, Moscow, Russian Federation"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"2026031007450736000_19.3.e269921.1","doi-asserted-by":"crossref","first-page":"709","DOI":"10.4244\/EIJ-D-21-00157","article-title":"Transcatheter aortic valve implantation in degenerated surgical aortic valves","volume":"17","author":"Tarantini","year":"2021","journal-title":"EuroIntervention"},{"key":"2026031007450736000_19.3.e269921.2","doi-asserted-by":"crossref","first-page":"4635","DOI":"10.1093\/eurheartj\/ehaf194","article-title":"2025 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"46","author":"Praz","year":"2025","journal-title":"Eur Heart 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Interv"},{"key":"2026031007450736000_19.3.e269921.6","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2024-260437","article-title":"Valve-in-Valve-in-Valve","volume":"17","author":"Cook","year":"2024","journal-title":"BMJ Case Rep"},{"key":"2026031007450736000_19.3.e269921.7","doi-asserted-by":"crossref","first-page":"S180","DOI":"10.1016\/j.carrev.2022.04.015","article-title":"A Case of Valve-in-Valve-in-Valve for Severe Aortic Regurgitation: Is Lifetime Management Upon Us?","volume":"53S","author":"Paz Rios","year":"2023","journal-title":"Cardiovasc Revasc Med"},{"key":"2026031007450736000_19.3.e269921.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(20)30750-6"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-269921","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T14:45:15Z","timestamp":1773153915000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-269921"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":8,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3,10]]},"published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1136\/bcr-2025-269921"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-269921","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]}}}