Snorkel Stenting During Transcatheter Aortic Valve Implantation: A Single-Center Study

Background and Objectives: Coronary obstruction (CO) is a potentially fatal complication that can occur during transcatheter aortic valve implantation (TAVI). The snorkel stenting technique was developed to mitigate the risk of CO. The aim of the current study was to evaluate the safety and clinical outcomes of snorkel stenting in patients at high risk of developing CO. Materials and Methods: All patients undergoing TAVI with snorkel stenting between January 2018 and December 2023 were retrospectively included. The primary outcome was the evaluation of perioperative CO and myocardial infarction (MI) at follow-up. Results: Between 2018 and 2023, a total of 1476 TAVI procedures were conducted, with 21 patients undergoing snorkel stenting for CO prevention. Median STS was 5.0 [IQR 3.0-8.0]. Four patients (19.0%) had a history of prior percutaneous coronary intervention, and 85.7% (n = 18) had a degenerated bioprosthesis. Preoperative multidetector CT revealed a mean sinus of Valsalva diameter of 24.6 ± 6.8 mm and a mean annulus area of 402.0 ± 59.7 mm². The mean heights of the left and right coronary ostia were 7.9 ± 3.3 mm and 10.6 ± 5.5 mm, respectively. Nine patients (42.9%) presented with severe aortic regurgitation. Snorkel stenting was performed on the left main coronary in nine cases, on the right coronary in 10 cases, and on both the left main and right coronary arteries in two cases. No procedural complications were observed. Postoperatively, there were no MIs; one patient suffered from a disabling stroke, and another patient required a new pacemaker implant. Thirty-day mortality rate was 0%. At a median follow-up of 1.25 years (IQR: 1.05-3.05), there were five rehospitalizations for heart failure, no aortic valve reinterventions, one disabling stroke (sub-acute), and one MI. Overall, four patients died, including two cardiovascular-related deaths. Conclusions: Snorkel stenting should be considered for selected high- or prohibitive-surgical-risk patients undergoing TAVI who are at increased risk of developing CO. This technique showed favorable procedural outcomes for preventing CO occurring during or in the perioperative period of TAVI procedures. The abstract of the present study was accepted for oral presentation at the New York Valves on 26 June 2025.