Why the study?
TAVR-in-TAVR can lead to coronary ostial obstruction from complex leaflet interactions, and coronary protection with provisional stent placement may be challenging.
Operators should be aware of the risk of guide catheter entrapment between valve frames during TAVR-in-TAVR procedures with coronary protection.
Raises caution for guide catheter entrapment in protected TAVR-in-TAVR; leaves open optimal prevention strategies.
Transcatheter aortic valve replacement (TAVR) for transcatheter heart valve failure has been suggested for high-risk patients. TAVR-in-TAVR, however, may lead to complex leaflet interactions causing coronary ostial obstruction, which is a devastating complication. Coronary protection with provisional stent placement may be challenging. We describe the first percutaneous transaxillary case of TAVR-in-TAVR with Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction (BASILICA) where guide catheters used for coronary protection were entrapped between the valve frames. We describe anatomical predictors and management considerations. Operators should be aware of this important complication during TAVR-in-TAVR valve placement.
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Qureshi et al. (2021) studied this question.
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