What question did this study set out to answer?

Evaluate the effectiveness of intraoperative indocyanine green (ICG) near-infrared angiography in redo aortic valve surgeries.

January 18, 2026The Thoracic and Cardiovascular Surgeon Reports0 citationsOpen Access

Intraoperative Indocyanine Green Near-Infrared Angiography for Redo Valve Replacement

BSBrian SolomonNaples Community Hospital Healthcare System ASAndreas SarantopoulosEuropean University Cyprus TCThomas CaranasosNaples Community Hospital Healthcare System

Key Result

SURPLUS combined with ICG–NIR angiography ensured coronary patency and improved ejection fraction to 60–65% in a patient with severe prosthetic stenosis post-TAVR.

Key Points

Evaluate the effectiveness of intraoperative indocyanine green (ICG) near-infrared angiography in redo aortic valve surgeries.
Conducted a redo aortic valve replacement in an 83-year-old woman post-TAVR.
Utilized Surgical Resection of Prosthetic Valve Leaflets Under Direct Vision (SURPLUS) technique.
Implemented low-dose indocyanine green (ICG) for near-infrared angiography during surgery.
Monitored real-time coronary opacification to ensure proper valve seating.
Achieved symmetric coronary opacification confirmed via NIR imaging.
Improved ejection fraction post-procedure, ranging from 60% to 65%.
Post-operative recovery was reported as uneventful.

Structured PICO

Does SURPLUS with intraoperative ICG-NIR angiography confirm coronary patency and ensure safe hemodynamic restoration in patients with failed TAVR and low coronary heights?

Population

n=1, 83-year-old woman with severe prosthetic aortic stenosis after prior TAVR (26-mm self-expanding Evolut), preserved left ventricular systolic function (LVEF 45-50%), extremely low coronary heights, and near-circumferential pannus and frame ingrowth.

Intervention

Surgical Resection of Prosthetic Valve Leaflets Under Direct Vision (SURPLUS) with implantation of a 23-mm balloon-expandable aortic valve and intraoperative 3-mg intravenous bolus of indocyanine green (ICG) near-infrared (NIR) angiography.

Outcome

Coronary patency assessed by real-time near-infrared fluorescence imaging and hemodynamic restoration assessed by intraoperative transesophageal echocardiography.surrogate

SURPLUS with intraoperative ICG-NIR angiography provides real-time assurance of coronary perfusion and safe hemodynamic restoration in patients with failed TAVR and challenging anatomy.

Limitations

limited to single-patient experience

Abstract

Background: Redo aortic interventions after failed transcatheter aortic valve replacement (TAVR) are challenging, particularly with low coronary heights and dense frame ingrowth. Case Description: An 83-year-old woman with prior TAVR developed severe prosthetic stenosis. Surgical Resection of Prosthetic Valve Leaflets Under Direct Vision (SURPLUS) with implantation of a balloon-expandable aortic valve and intraoperative low-dose indocyanine green (ICG) near-infrared (NIR) angiography was performed. Real-time NIR imaging confirmed symmetric coronary opacification. The valve was well seated with improved ejection fraction (60–65%), and recovery was uneventful. Conclusion: SURPLUS with ICG–NIR angiography ensured coronary patency and safe hemodynamic restoration.

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