Why the study?
Unusual coronary artery supply with anatomical variations may increase procedural risk in TAVR, making SAVR a suitable modality.
SAVR is a safe and effective alternative to TAVR in patients with severe aortic stenosis and anomalous coronary artery origins that pose a high risk for coronary obstruction.
May support SAVR consideration in select high-risk anomalous coronary anatomy; leaves open need for comparative data versus TAVR.
Aortic stenosis (AS) is a common valvular heart disease in the elderly population. Transcatheter aortic valve replacement (TAVR) is a preferred modality for severe symptomatic AS management in elderly patients with high surgical risk. However, unusual coronary artery supply with anatomical variations may increase the procedural risk in TAVR, making surgical aortic valve replacement (SAVR) a suitable modality. This article presents a case of a 77-year-old male with severe symptomatic AS with an uncommon coronary anomaly where all three major coronary arteries originate from the right coronary sinus, posing a high risk for coronary obstruction during TAVR. The SAVR procedure was performed successfully, allowing for direct visualization and protection of the anomalous coronary ostia. This case emphasizes the crucial role of pre-procedural catheterization and surgical planning in patients with atypical coronary artery supply.
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Chandna et al. (2025) studied this question.
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