Alternatives to traditional aortic valve replacement now form part of
the valve surgeon's armamentarium. Sutureless valves offer decreased
bypass and crossclamp times, excellent maneuverability, and promising
outcomes. We present a case of a sutureless aortic valve replacement for
a late failed David procedure, complicated by post-operative development
of severe paravalvular regurgitation. We attempted off-label balloon
post-dilation to improve expansion of the valve, however paravalvular
regurgitation persisted. The patient underwent subsequent aortic valve
replacement using a mechanical valve and experienced no further
paravalvular leak.