Key result
Unprotected TAVI yields zero adverse cardiovascular events at ~18 months despite low LMCA takeoff.
Why the study?
Management of TAVI in patients with a critically low LMCA ostial height requires weighing coronary obstruction risk against the potential complications of prophylactic stenting through individualized anatomical and Heart Team assessment.
Case Report (n=1)
No
Illustrates how individualized CT anatomical assessment (such as a wide 31 mm sinus and absence of bulky leaflet calcification) and Heart Team planning can guide unprotected TAVI in select patients with critically low LMCA height, though it does not prove general safety.
Answers are grounded in this paper and cite their sources.
May inform individualized TAVI planning in low coronary height; leaves open the role of unprotected implantation pending controlled studies.
A 66-year-old woman with severe symptomatic aortic stenosis (STS-PROM 5.15%; EuroSCORE II 3.66%), right carotid occlusion, 50% left carotid stenosis, and a preference for TAVI underwent multidisciplinary assessment. Computed tomography demonstrated a 6 mm left main coronary artery (LMCA) ostial height, hypoplastic right coronary artery, 31 mm left coronary sinus, and no bulky calcification facing the LMCA. Following Heart Team assessment of obstruction risk and the potential complications of prophylactic stenting, transfemoral TAVI was performed without coronary protection using a 29 mm recapturable self-expanding valve, with emergency revascularization, hemodynamic support, and surgical backup available. Preserved left coronary perfusion after 18 mm balloon predilatation provided reassurance but could not exclude obstruction during valve deployment. Recovery was uneventful, with no reported adverse cardiovascular events during approximately 18 months of follow-up. Favorable sinus anatomy may inform procedural planning but cannot independently establish protection against coronary obstruction. This single case illustrates individualized anatomical assessment and Heart Team decision-making, not the general safety of omitting coronary protection in similarly high-risk patients.
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Karakuş et al. (2026) conducted a case report in Severe symptomatic aortic stenosis with critically low LMCA ostial height (6 mm) (n=1). Transfemoral TAVI without coronary protection using a 29 mm recapturable self-expanding valve was evaluated on Adverse cardiovascular events and coronary obstruction. Unprotected transfemoral TAVI with a 29 mm self-expanding valve in a patient with a 6 mm LMCA height resulted in 0 adverse cardiovascular events over ~18 months.
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