Related Experiment Video
Updated: Jun 16, 2026
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Case Report: Selective metal cell excision during open TAVR implantation preserves coronary access while maintaining
Julia E Katter1, John Paul Tannous2, Katherine A Roberts1,3
1Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
Background:
Coronary access following transcatheter aortic valve replacement (TAVR) remains challenging and should be carefully considered when planning re-intervention for patients with structural valve degeneration. Current management options [valve-in-valve (ViV) TAVR or surgical aortic valve replacement and TAVR explant] both carry significant benefits and limitations.
Case Presentation:
A 78-year-old female with a degenerated 23 mm Sapien 3 TAVR presented with severe prosthetic stenosis, moderate paravalvular leak (PVL), and progressive dyspnea. A standard TAVR ViV had a suboptimal risk of not addressing the PVL and worsening prosthesis-patient mismatch, whereas TAVR explantation and SAVR with root enlargement carried an increased surgical risk.
Intervention:
Open surgical TAVR explantation with direct re-implantation of a 26 mm Sapien Ultra valve, combined with selective metal cells excision facing the left main coronary artery (LMCA) and felt patch repair of the PVL.
Outcome:
The patient achieved immediate resolution of severe stenosis and elimination of PVL, with sustained clinical improvement at six-month follow-up and a more favorable coronary access.
Conclusion:
Selective metal cell excision during open TAVR implantation is a technically feasible approach to prophylactically preserve coronary access while maintaining valve integrity and function. This technique may benefit high-risk patients requiring TAVR explants and root enlargement SAVRs.
