A snare technique for valve-in-valve transcatheter aortic valve replacement in a stented coarctation of the aorta: a case report

Background Self-expanding valves are effective for transcatheter aortic valve replacement (TAVR); however, device delivery can be challenging in patients with a distorted aortic anatomy. Herein, we report the successful use of a snare technique to facilitate valve delivery in a patient with a previously stented aortic coarctation and poststenotic dilatation. Case summary A 66-year-old woman with Turner syndrome, prior aortic coarctation stenting, and surgical bioprosthetic aortic valve replacement presented with symptomatic severe prosthetic aortic valve stenosis. Advancement of a 23-mm Medtronic Evolut FX valve was hindered by the small caliber of the patent aortic stent and marked aortic tortuosity. A gooseneck snare was used to apply inferior traction while the delivery system was advanced from the contralateral femoral access, redirecting the catheter toward the center of the stented segment and enabling successful valve deployment. Conclusion Snare-assisted redirection represents a valuable adjunctive strategy to facilitate self-expanding TAVR valve delivery in patients with complex or previously stented aortic anatomy. Durable valve function without complications was observed in the patient at a 2-year follow-up.