Key result
Surgical removal of prosthetic valve leaflets followed by direct transcatheter aortic valve implantation was successfully performed in a patient at high risk for coronary flow impairment.
Why the study?
Coronary flow compromise is a significant hazard during transcatheter aortic valve re-intervention, making coronary flow preservation particularly challenging.
Case Report (n=1)
An open-aorta, direct transcatheter valve-in-valve implantation may represent a viable hybrid alternative for TAVR re-intervention when catheter techniques for coronary flow preservation are not applicable.
May offer hybrid option for select high-risk valve-in-valve cases when coronary protection fails; hypothesis-generating, needs prospective validation.
BACKGROUND: Coronary flow compromise is a significant risk of transcatheter aortic valve therapy. Warranting preservation of coronary flow is even more challenging with transcatheter aortic valve re-intervention since the implantation of a transcatheter valve within a degenerated bioprosthetic or transcatheter valve increases significantly this hazard. CASE SUMMARY: We present a case of heart failure secondary to transcatheter aortic valve degeneration requiring a transcatheter aortic valve re-intervention. Pre-operative imaging studies demonstrated a high risk for iatrogenic coronary flow impairment. The patient underwent a successful surgical removal of the prosthetic valve leaflets followed by direct transcatheter aortic valve implantation. CONCLUSION: We reviewed the literature on the approach to difficult coronaries in transcatheter aortic valve therapy, and we describe an innovative hybrid approach that may represent a viable alternative in cases where catheter techniques of coronary flow preservation are not applicable.
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Calcaterra et al. (2021) conducted a case report in Heart failure secondary to transcatheter aortic valve degeneration (n=1). Surgical removal of prosthetic valve leaflets followed by direct transcatheter aortic valve implantation was evaluated on Procedural success. Surgical removal of prosthetic valve leaflets followed by direct transcatheter aortic valve implantation was successfully performed in a patient at high risk for coronary flow impairment.
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