Keeping the flow: A case series on snorkel/chimney stenting during transcatheter aortic valve replacement

Abstract

Background

Coronary artery occlusion is a rare but potentially fatal complication following transcatheter aortic valve replacement (TAVR), particularly in patients with high-risk anatomical features such as low coronary takeoff or shallow sinuses of Valsalva. Snorkel/chimney stenting has emerged as a feasible bailout or planned strategy to maintain coronary perfusion in these cases.

Objective

This case series describes the procedural approach, technical challenges, and clinical outcomes of three patients who underwent snorkel stenting of the coronary arteries following TAVR as well as one patient with concerns for coronary obstruction before TAVR.

Methods

Four high-risk patients underwent TAVR with planned or emergent snorkel stenting to prevent or manage coronary obstruction. Outcomes were assessed based on procedural success, coronary patency, and survival.

Results

Snorkel stenting was technically successful in three cases, preserving immediate coronary perfusion, while a fourth case had preparations for snorkel stenting but was not needed as the TAVR bioprosthesis did not occlude the coronary artery. Three patients survived for approximately 1–2 years post-intervention before succumbing to non-cardiac or unrelated complications and expired. Challenges included optimal stent positioning to minimize leaflet interaction and the potential for thrombotic complications.

Conclusion

This case series highlights both the feasibility and limitations of snorkel stenting as a coronary protection strategy post-TAVR. While short-term technical success was achieved, long-term survival remained limited in this high-risk population. Further research is needed to optimize patient selection, procedural strategies, and long-term management.