Transfemoral TAVR was successfully performed without residual regurgitation or coronary obstruction in a patient with severe aortic insufficiency after a prior David procedure.
Case Report (n=1)
Is transfemoral TAVR feasible and safe in a patient with severe aortic insufficiency following a prior David procedure?
Transfemoral TAVR using a balloon-expandable valve is feasible for treating severe aortic insufficiency after a prior David procedure when guided by careful anatomical planning.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) for aortic insufficiency (AI) after valve-sparing aortic root replacement (VSARR) presents unique anatomical and procedural challenges. CASE SUMMARY: We report successful transfemoral TAVR in a 68-year-old man with severe AI following a prior David procedure. Procedural planning incorporated gated computed tomography assessment of graft dimensions and coronary heights. Device sizing and deployment strategy relied on the left main (LM) ostium as a fluoroscopic landmark and the graft diameter to define the anchoring zone. A balloon-expandable valve was selected with >15% oversizing. The device was deployed successfully without residual regurgitation or coronary obstruction. DISCUSSION: This case highlights the feasibility of TAVR after VSARR with AI and emphasizes the importance of integrating prior surgical technique and graft anatomy into transcatheter procedural planning. TAKE-HOME MESSAGE: Procedural planning using anatomical landmarks may aid in the safe deployment of TAVR in failed VSARR with AI.
Makhdoum et al. (Fri,) conducted a case report in Severe aortic insufficiency following a prior David procedure (n=1). Transfemoral transcatheter aortic valve replacement (TAVR) was evaluated on Procedural success (device deployed successfully without residual regurgitation or coronary obstruction). Transfemoral TAVR was successfully performed without residual regurgitation or coronary obstruction in a patient with severe aortic insufficiency after a prior David procedure.