Related Experiment Video
Updated: May 11, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Successful Transcatheter Aortic Valve Replacement in a Patient with Previous Aortic Coarctation Bypass Graft: A Case
Georgios E Papadopoulos1, Ilias Ninios1, Konstantinos Papazoglou1
1Interbalkan European Medical Center, Thessaloniki, Greece.
Background:
Transfemoral (TF) TAVR can be challenging in patients with prior aortic coarctation repair and bypass grafts due to extreme tortuosity.
Case:
A 74-year-old man with severe symptomatic aortic stenosis and a prior left-subclavian-to-descending aortic bypass presented for TAVR. CT showed a large, calcified annulus (perimeter-derived diameter 27.6 mm; area 573.7 mm²) and a serpiginous, calcified bypass graft. After initial failure to advance the system through the graft, we pre-shaped a Lunderquist wire with an acute bend ~40 cm from the tip to redirect the delivery vector. A 27.5-mm balloon-expandable MyVal was then advanced and deployed uneventfully, with no paravalvular leak.
Conclusion:
Intentional pre-shaping of a stiff wire can facilitate TF device traversal across aorto-subclavian bypass grafts with severe tortuosity, enabling safe, precise deployment when TF remains the preferred route.
