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, 2026Open Access

Intraoperative Indocyanine Green Near-Infrared Angiography for Redo Valve Replacement

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.

Main Result

Absolute Event Rate: 0% vs 0%

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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Cite This Study

Solomon et al. (Fri,) reported a other. 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.

synapsesocial.com/papers/696c774feb60fb80d13958de https://doi.org/https://doi.org/10.1055/a-2789-2530

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