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Updated: May 31, 2026

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Transcatheter Aortic Valve Replacement After David Procedure for Severe Aortic Regurgitation
Ahmad Makhdoum1, Muhammed Suleman2, Warkaa Shamkhani3
1Unit of Cardiac Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
Background:
Transcatheter aortic valve replacement (TAVR) for aortic insufficiency (AI) after valve-sparing aortic root replacement (VSARR) presents unique anatomical and procedural challenges.
Case Summary:
We report successful transfemoral TAVR in a 68-year-old man with severe AI following a prior David procedure. Procedural planning incorporated gated computed tomography assessment of graft dimensions and coronary heights. Device sizing and deployment strategy relied on the left main (LM) ostium as a fluoroscopic landmark and the graft diameter to define the anchoring zone. A balloon-expandable valve was selected with >15% oversizing. The device was deployed successfully without residual regurgitation or coronary obstruction.
Discussion:
This case highlights the feasibility of TAVR after VSARR with AI and emphasizes the importance of integrating prior surgical technique and graft anatomy into transcatheter procedural planning.
Take-Home Message:
Procedural planning using anatomical landmarks may aid in the safe deployment of TAVR in failed VSARR with AI.
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