Dedicated Transcatheter Valve for Pure Aortic Regurgitation in a Failed Stentless Bioprosthesis

Figures

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  Visual Summary. JenaValve Trilogy System for Pure Aortic Regurgitation in a Failed ATS 3f Stentless Bioprosthesis Degeneration of a stentless ATS 3f model 1000 aortic bioprosthesis resulted in severe pure aortic regurgitation (AR) and a high-risk valve-in-valve (ViV) anatomy characterized by the absence of a rigid landing zone and risk of sinus sequestration. Implantation of a dedicated transcatheter heart valve (THV) (JenaValve Trilogy System) enabled stable anchoring and complete resolution of regurgitation without coronary obstruction. STJ = sinotubular junction; TAVR = transcatheter aortic valve replacement. Images reproduced with permission of JenaValve Technology, Inc.

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  Figure 1. Coronary Angiography (A) Left coronary artery. (B) Right coronary artery. (C) Aortogram. Saphenous venous graft is visible (yellow arrow). LAD = left anterior descending artery; LCX = left circumflex artery; OM1 = obtuse marginal 1.

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  Figure 2. Computed Tomography–Based Preprocedural 3Mensio Evaluation (A) Annulus dimensions at the level of the 3f valve stent. (B) LVOT dimensions at 4 mm from the annulus. (C) Sinus of Valsalva diameters. (D) Coronal view showing a severe kinking of the root replacement graft at the level of the 3 fixation sutures (yellow arrow). (E) Sinotubular junction diameters, at 30.9 mm from the annulus. (F) Ilio-femoral axes reconstruction with vessel diameters. LVOT = left ventricular outflow tract. Images reproduced with permission of JenaValve Technology, Inc.

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  Figure 3. Computed Tomography–Based 3Mensio Evaluation for Coronary Risk Obstruction and Sinus Sequestration (A) Left main (LM) height = 6 mm and (B) right coronary artery (RCA) height = 11.3 mm. (C and D) Virtual to coronary distance for RCA (1 = 7.1 mm) and LM (2 = 6.6 mm) when tested with a virtual transcatheter heart valve EvolutR 34-mm phantom.