Key result
Redo-TAVI with chimney stenting resolves RCA obstruction and reduces mean aortic gradient to ~15 mmHg.
Why the study?
Redo transcatheter aortic valve implantation in patients with prior transapical SAPIEN 3 valves carries a significant risk of coronary obstruction, and chimney stenting is a strategy to maintain coronary perfusion in high-risk valve-in-valve procedures.
Case Report (n=1)
No
Pre-emptive coronary wiring and chimney stenting combined with comprehensive CT planning enables safe and effective cross-platform transfemoral redo-TAVI in patients with high-risk coronary anatomy and prior transapical balloon-expandable valves.
Answers are grounded in this paper and cite their sources.
Supports pre-emptive coronary protection as a bailout strategy in high-risk cross-platform redo-TAVI; leaves open long-term stent patency and valve durability beyond this single case.
Background: Redo transcatheter aortic valve implantation (TAVI) in patients with prior transapical SAPIEN 3 valves carries a significant risk of coronary obstruction. Chimney stenting is an established strategy to maintain coronary perfusion in high-risk valve-in-valve (ViV) procedures. Case Description: An 87-year-old woman presented with NYHA class IV symptoms due to severe restenosis of a 20-mm SAPIEN 3 valve implanted in 2017. Computed tomography revealed stent extension beyond the sinotubular junction, posing a risk of right coronary artery (RCA) occlusion. A transfemoral redo-TAVI using a 23-mm Medtronic Evolut FX+ valve was performed with pre-positioned chimney stenting. During valve deployment, inferior ST-segment elevation occurred, necessitating immediate RCA stenting. A second distal RCA stent addressed residual stenosis. Final angiography confirmed preserved coronary flow and optimal valve function; Discussion: Careful preprocedural evaluation—including CT-based assessment of coronary height, sinus anatomy, and virtual valve modeling—is essential in high-risk ViV or redo-TAVI cases. The chimney technique provides an effective bailout for acute coronary obstruction, while procedural strategies such as commissural alignment and the cusp-overlap technique can optimize procedural and hemodynamic outcomes.; Conclusions: Planned coronary protection using chimney stenting enables safe and effective redo transfemoral TAVI in patients with complex anatomy and prior transapical valve implantation, ensuring hemodynamic success and minimizing complications.
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Stanisavljevikj et al. (2026) conducted a case report in Severe restenosis and structural degeneration of a previously implanted 20-mm SAPIEN 3 transapical bioprosthetic aortic valve (n=1). Transfemoral redo-TAVI using a 23-mm Medtronic Evolut FX+ valve with pre-emptive right coronary artery chimney stenting was evaluated on Procedural and hemodynamic success (mean transvalvular aortic gradient and coronary flow). Transfemoral redo-TAVI with a 23-mm Evolut FX+ valve and chimney stenting reduced the mean aortic gradient from 49 to 15.2 mmHg while resolving acute RCA obstruction.
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