Transcatheter Bailout: An Important Option During Complex Aortic Surgery

This report presents the case of a 66-year-old man with acute torrential aortic insufficiency after a Ross procedure 20 years earlier, a biologic aortic valve replacement 16 years earlier, and a transcatheter valve-in-valve 4 years earlier. He underwent third-time sternotomy, revealing that the pulmonary autograft was heavily calcified and frozen to the homograft. The previous transcatheter valve-in-valve was explanted. The previous bioprosthetic valve was adhered in place, necessitating emergency deployment of a replacement transcatheter valve-in-valve. The patient recovered well, with normal aortic valve function. Techniques from cardiac surgery and interventional cardiology are rapidly converging in invasiveness, thus making hybrid strategies increasingly important in complex cases.