Key result
Redo TAVR using a SAPIEN 3 valve combined with meticulous CT planning and prophylactic coronary wiring successfully prevented coronary obstruction in a patient with a degenerated ACURATE Neo2 valve and high-risk anatomy.
Why the study?
Valve-specific ACURATE Neo2 geometry increases coronary obstruction risk during redo TAVR, necessitating careful imaging and coronary protection strategies.
Does a structured, imaging-guided redo TAVR approach with prophylactic coronary wiring prevent right coronary artery obstruction in patients with degenerated ACURATE Neo2 valves and high-risk anatomy?
Case Report (n=1)
Does a structured, imaging-guided redo TAVR approach with prophylactic coronary wiring prevent right coronary artery obstruction in patients with degenerated ACURATE Neo2 valves and high-risk anatomy?
This case demonstrates that a structured technical approach integrating multimodality imaging and prophylactic coronary protection enables safe redo TAVR in degenerated ACURATE Neo2 valves with high-risk coronary anatomy.
May enable safe redo TAVR in select high-risk ACURATE Neo2 cases; case report leaves open need for prospective validation before wider use.
OBJECTIVES: Here we describe a step-by-step, imaging-guided technical approach to redo transcatheter aortic valve replacement (TAVR) in a degenerated ACURATE Neo2 valve (Boston Scientific) with high-risk right coronary artery (RCA) anatomy and highlight strategies to prevent coronary obstruction during valve-in-valve implantation. KEY PROCEDURAL STEPS: A 76-year-old man who previously underwent TAVR using a 27-mm ACURATE Neo2 valve presented with heart failure due to severe prosthetic aortic regurgitation. Preprocedural computed tomography demonstrated a critically high-risk anatomy for RCA obstruction, with the coronary ostium originating between the upper and lower crowns of the Neo2 frame and limited sinus of Valsalva accommodation. Because of his prohibitive surgical risk, redo TAVR was performed using a 26-mm SAPIEN 3 valve (Edwards Lifesciences). The procedure incorporated meticulous computer tomography-based planning, prophylactic RCA wiring for coronary protection, and stepwise, high and controlled valve deployment with real-time positional adjustments to achieve precise alignment at the Neo2 upper crown. POTENTIAL PITFALLS: Valve-specific ACURATE Neo2 geometry increases coronary obstruction risk, making careful imaging, valve selection, and coronary protection essential.
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Kharsa et al. (2026) conducted a case report in Severe prosthetic aortic regurgitation (degenerated ACURATE Neo2 valve) (n=1). Redo TAVR (26-mm SAPIEN 3 valve) with prophylactic coronary wiring was evaluated on Procedural success without coronary obstruction. Redo TAVR using a SAPIEN 3 valve combined with meticulous CT planning and prophylactic coronary wiring successfully prevented coronary obstruction in a patient with a degenerated ACURATE Neo2 valve and high-risk anatomy.
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