Key result
EXCALIBUR scissor-based leaflet modification prevents coronary obstruction during high-risk valve-in-valve TAVR.
Why the study?
To mitigate the high risk of coronary obstruction in a patient with a degenerated surgical aortic bioprosthesis undergoing valve-in-valve transcatheter aortic valve replacement.
Does the EXCALIBUR mechanical leaflet modification technique prevent coronary obstruction in a patient undergoing high-risk valve-in-valve TAVR?
Case Report (n=1)
Does the EXCALIBUR mechanical leaflet modification technique prevent coronary obstruction in a patient undergoing high-risk valve-in-valve TAVR?
The EXCALIBUR scissor-based mechanical leaflet modification technique is a feasible approach to prevent coronary obstruction during high-risk valve-in-valve TAVR.
May support EXCALIBUR feasibility in select high-risk valve-in-valve TAVR; leaves open need for prospective validation.
An 81-year-old woman with a degenerated surgical aortic bioprosthesis and high predicted risk of coronary obstruction underwent valve-in-valve transcatheter aortic valve replacement. Preprocedural imaging showed low coronary ostial height and unfavorable sinus anatomy. To mitigate this risk, we performed Ensizor eXCision of Aortic Leaflets In Bioprostheses at Unacceptable coronary occlusion Risk, a novel mechanical leaflet modification technique using a scissor-based catheter system. Both bioprosthetic leaflets were successfully split under imaging guidance, with immediate regurgitation confirming effective modification. Subsequent valve implantation was uneventful, with preserved coronary flow on final imaging. This case illustrates the feasibility of a controlled mechanical approach to prevent coronary obstruction during high-risk valve-in-valve procedures.
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Cabezas et al. (2026) conducted a case report in Degenerated surgical aortic bioprosthesis with high risk of coronary obstruction (n=1). EXCALIBUR technique (mechanical leaflet modification using a scissor-based catheter system) was evaluated on Prevention of coronary obstruction. The EXCALIBUR technique, a novel mechanical leaflet modification using a scissor-based catheter system, successfully prevented coronary obstruction during high-risk valve-in-valve TAVR.
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