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Updated: Sep 27, 2026
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
A case of challenging percutaneous coronary intervention following surgical aortic valve replacement with a
Yuta Azumi1, Tatsuya Nakama1, Kotaro Obunai1
1Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan.
Insights
Percutaneous coronary intervention (PCI) after sutureless aortic valve replacement (SL-AVR) can be challenging due to the bioprosthesis potentially obstructing coronary access. A novel "Mother, Child, and Grandchild Technique" successfully enabled PCI in a challenging case.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
- Medical Device Technology
Background:
- Symptomatic severe aortic valve stenosis and right coronary artery (RCA) stenosis necessitate combined treatment.
- Sutureless aortic bioprosthesis (SL-AVR) implantation, like the Perceval valve, is an option for aortic valve replacement.
- Post-SL-AVR, percutaneous coronary intervention (PCI) may be required, but coronary ostial access can be hindered by the bioprosthesis.
Abstract:
A 71-year-old man with symptomatic severe aortic valve stenosis and stenosis of the proximal right coronary artery (RCA) underwent aortic valve replacement with Perceval (LivaNova, London, UK), a sutureless aortic bioprosthesis with a self-expanding open-cell designed nitinol frame (SL-AVR). Seven weeks after the SL-AVR, percutaneous coronary intervention (PCI) to the RCA was required. However, engagement of the guiding catheter (GC) was challenging because the RCA ostium was jailed by the strut of the Perceval. Therefore, the "Mother, Child, and Grandchild Technique" was used. A 4-Fr diagnostic catheter (DC) was partially engaged, and a support type 0.014-inch guidewire (GW) was inserted into the distal RCA. The DC was replaced by a 6-Fr GC. To fill the gap between the 0.014-inch GW and 6-Fr GC, a 5-Fr tapered inner sheath (IS, tip size was 3.0-Fr, used as Child catheter) was inserted into the 6-Fr GC (Mother catheter), and a 2.6-Fr microcatheter (Grandchild catheter) was inserted into the 5-Fr IS. Therefore, the gap between the 0.014-inch GW and 6-Fr GW was obliterated. Finally, we successfully inserted the PCI system and engaged the GC. RCA stenosis was treated using the conventional PCI technique. Herein, we report a case of successful PCI subsequent to SL-AVR. <Learning objective: The technical feasibility of percutaneous coronary intervention (PCI) following aortic valve replacement with a sutureless aortic bioprosthesis with a self-expanding open-cell designed nitinol frame (SL-AVR) remains unclear. In this report, we describe a case of challenging PCI following SL-AVR.>.
