"Ménage à Trois": Use of 2 Supplemental Buddy Wires During TAVI

We herein present clinical images illustrating a transcatheter aortic valve implantation within an extremely calcified aortic valve, which posed considerable difficulty in crossing the aortic annulus. To gain maximum support, we used 2 buddy wires to allow a balloon predilation and then a successful crossing of the transcatheter heart valve. This technique provides additional support for those performing this procedure and may be included in the armamentarium of transcatheter aortic valve specialists.