Key result
Zero-contrast pressure-guided TAV-in-SAV achieves ~8 mmHg mean gradient at 12 months with preserved renal function.
Case Report (n=1)
No
Continuous left ventricular pressure monitoring via a specialized wire can effectively guide zero-contrast transcatheter aortic valve-in-valve implantation and optimization in patients with renal dysfunction.
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May enable contrast avoidance during ViV TAVR in renal impairment; hypothesis-generating and requires prospective validation before adoption.
An 89-year-old man with structural deterioration of a surgical aortic bioprosthesis and renal dysfunction underwent zero-contrast transcatheter aortic valve-in-surgical valve (TAV-in-SAV) implantation. A SavvyWire provided continuous left ventricular pressure monitoring and rapid pacing during the procedure. After implantation of a 23-mm self-expanding valve, a residual transvalvular gradient was detected, prompting balloon postdilatation under rapid pacing. Repeat invasive hemodynamic assessment showed improvement, and echocardiography demonstrated a mean gradient of 12 mmHg. At 12 months, the patient was in New York Heart Association class I, with preserved renal function and a mean gradient of 8 mmHg. Continuous pressure monitoring may support intraprocedural assessment and guide valve optimization when contrast exposure is being avoided in patients with renal dysfunction.
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Miura et al. (2026) conducted a case report in Structural deterioration of a surgical aortic bioprosthesis and renal dysfunction (n=1). Zero-contrast transcatheter aortic valve-in-surgical valve implantation guided by continuous left ventricular pressure monitoring (SavvyWire) was evaluated on Mean transvalvular gradient and clinical status at 12 months. Zero-contrast TAV-in-SAV guided by continuous pressure monitoring achieved a postprocedural mean gradient of 12 mmHg and 8 mmHg at 12 months with functional class I and preserved renal function.
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