Valve-in-Valve Transapical Transcatheter Aortic Valve Replacement with Concomitant Percutaneous Coronary...

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Case Reports

Background:

• Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is increasingly utilized for elderly, high-risk patients needing repeat aortic valve procedures.
• Common ViV-TAVR access routes include transfemoral, transcarotid, and transsubclavian approaches.
• Severe peripheral vascular disease can contraindicate standard ViV-TAVR approaches, necessitating alternative strategies.

Purpose of the Study:

• To present a rare case of transapical ViV-TAVR in a patient with severe peripheral vascular disease.
• To highlight the utility of the transapical approach for ViV-TAVR when other access routes are contraindicated.
• To demonstrate the feasibility of concomitant percutaneous coronary intervention during transapical ViV-TAVR.

Main Methods:

• A case report detailing the procedure for a 79-year-old male with severe prosthetic valve degeneration and high surgical risk.
• The patient had contraindications for transfemoral, carotid, and subclavian access due to severe peripheral arterial disease.
• The procedure involved transapical ViV-TAVR using a Sapien S3 valve and a left main coronary artery snorkel stent.

Main Results:

• Successful transapical ViV-TAVR was performed in a patient with prohibitive peripheral vascular disease.
• A left main coronary artery snorkel stent was successfully deployed for protection during the procedure.
• This case demonstrates the feasibility of transapical ViV-TAVR in complex, high-risk patients.

Conclusions:

• Transapical ViV-TAVR is a critical alternative for patients ineligible for transfemoral ViV-TAVR due to severe peripheral vascular disease.
• The availability of diverse TAVR approaches is essential for managing high-risk patient populations.
• This case underscores the importance of tailored surgical strategies in complex aortic valve interventions.