High-Risk TAV-in-TAV

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-08 DOI:10.1016/j.jaccas.2025.105340

Lida Koskina MBBS , Andrew Ndakotsu MD , Antony Kaliyadan MD , John Wang MD , Shaikh B. Iqbal DO

{"title":"High-Risk TAV-in-TAV","authors":"Lida Koskina MBBS , Andrew Ndakotsu MD , Antony Kaliyadan MD , John Wang MD , Shaikh B. Iqbal DO","doi":"10.1016/j.jaccas.2025.105340","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study is to describe a high-risk transcatheter aortic valve-in-valve in a Lotus valve requiring coronary artery protection.</div></div><div><h3>Key Steps</h3><div>Thorough preoperative assessment for valve sizing and coronary obstruction risk assessment are performed. Access is obtained for a pigtail catheter, a guiding catheter for percutaneous coronary intervention, and the transcatheter aortic valve replacement delivery system. Coronary access is secured with a coronary wire and a guide extension catheter before valve deployment. Proper alignment of the new valve is ensured. A snorkel stent is deployed and maximal expansion is ensured.</div></div><div><h3>Potential Pitfalls</h3><div>Coronary artery anatomy, which is at high risk for obstruction, can lead to coronary ischemia or sequestration after valve deployment. Improper alignment of the new valve can lead to poor apposition and paravalvular leak. Injury to the aorta during valve deployment or when postdilation is required.</div></div><div><h3>Take-Home Message</h3><div>Successful transcatheter aortic valve-in-valve in a Lotus valve is feasible with proper preoperative planning, individualized device selection, and coronary protection when indicated.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 31","pages":"Article 105340"},"PeriodicalIF":0.0000,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Case reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666084925021229","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

The objective of this study is to describe a high-risk transcatheter aortic valve-in-valve in a Lotus valve requiring coronary artery protection.

Key Steps

Thorough preoperative assessment for valve sizing and coronary obstruction risk assessment are performed. Access is obtained for a pigtail catheter, a guiding catheter for percutaneous coronary intervention, and the transcatheter aortic valve replacement delivery system. Coronary access is secured with a coronary wire and a guide extension catheter before valve deployment. Proper alignment of the new valve is ensured. A snorkel stent is deployed and maximal expansion is ensured.

Potential Pitfalls

Coronary artery anatomy, which is at high risk for obstruction, can lead to coronary ischemia or sequestration after valve deployment. Improper alignment of the new valve can lead to poor apposition and paravalvular leak. Injury to the aorta during valve deployment or when postdilation is required.

Take-Home Message

Successful transcatheter aortic valve-in-valve in a Lotus valve is feasible with proper preoperative planning, individualized device selection, and coronary protection when indicated.

查看原文本刊更多论文

高风险TAV-in-TAV

目的：本研究的目的是描述一种需要冠状动脉保护的高风险经导管主动脉瓣内置换术。术前对瓣膜大小和冠状动脉阻塞风险进行全面评估。获得了经皮冠状动脉介入治疗的导管导管，经导管主动脉瓣置换输送系统。在瓣膜部署前，冠状动脉通道用冠状动脉导线和导管延伸导管固定。确保新阀门的正确对准。采用通气管支架，保证最大的膨胀。潜在的缺陷冠状动脉解剖是阻塞的高风险，在瓣膜置放后可能导致冠状动脉缺血或隔离。新阀门的不正确对准可能导致放置不良和瓣旁泄漏。在瓣膜置放期间或需要后扩张时对主动脉的损伤。通过适当的术前计划、个体化的器械选择和冠状动脉保护，经导管主动脉瓣内瓣膜置入莲花瓣膜是可行的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊