Key result
Short-in-tall TAV-in-TAV with RCA protection successfully treats premature valve degeneration without bailout stenting.
Why the study?
Redo transcatheter aortic valve replacement (TAV-in-TAV) is technically challenging.
Case Report (n=1)
This case highlights the technical challenges of coronary access during redo TAVR and emphasizes the need to consider lifetime coronary access during the index valve selection.
Demonstrates feasibility of protected short-in-tall TAV-in-TAV; leaves open optimal strategies and generalizability.
BACKGROUND: Redo transcatheter aortic valve replacement (TAVR; TAV-in-TAV procedure) is technically challenging. We report a case of TAV-in-TAV requiring right coronary artery (RCA) protection. CASE SUMMARY: An 81-year-old man underwent TAVR with a self-expanding valve in 2021 and presented in 2025 with heart failure symptoms. Multimodality imaging demonstrated severe aortic regurgitation from premature structural valve degeneration. A short-in-tall TAV-in-TAV strategy was planned. Bulky leaflet calcification near the RCA ostium prompted coronary protection. After difficult RCA engagement requiring multiple access changes, the valve was deployed using the engaged guiding catheter as a fluoroscopic landmark. Coronary flow was preserved without bailout stenting. No residual regurgitation was observed on postprocedural imaging. DISCUSSION: We highlight the importance of preprocedural planning in redo TAVR and illustrate real-world challenges in coronary access despite meticulous planning. TAKE-HOME MESSAGES: Preprocedural planning and access flexibility are essential in redo TAVR. Lifetime coronary access should be considered during index valve selection.
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Chin et al. (2026) conducted a case report in Premature structural valve degeneration requiring redo TAVR (n=1). TAV-in-TAV with right coronary artery protection was evaluated on Procedural success (preservation of coronary flow and absence of residual regurgitation). A short-in-tall TAV-in-TAV strategy with right coronary artery protection successfully treated premature structural valve degeneration, preserving coronary flow without bailout stenting.
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