Successful Transcatheter Aortic Valve Replacement in a Patient with Previous Aortic Coarctation Bypass Graft: A Case Report

Background Transfemoral (TF) TAVR can be challenging in patients with prior aortic coarctation repair and bypass grafts due to extreme tortuosity. Case A 74‐year‐old man with severe symptomatic aortic stenosis and a prior left‐subclavian‐to‐descending aortic bypass presented for TAVR. CT showed a large, calcified annulus (perimeter‐derived diameter 27.6 mm; area 573.7 mm²) and a serpiginous, calcified bypass graft. After initial failure to advance the system through the graft, we pre‐shaped a Lunderquist wire with an acute bend ~40 cm from the tip to redirect the delivery vector. A 27.5‐mm balloon‐expandable MyVal was then advanced and deployed uneventfully, with no paravalvular leak. Conclusion Intentional pre‐shaping of a stiff wire can facilitate TF device traversal across aorto–subclavian bypass grafts with severe tortuosity, enabling safe, precise deployment when TF remains the preferred route.