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TAVR in a Small Surgical Bioprosthesis With a Kinked Aortic Graft Using an Intra-Annular Self-Expanding Valve
Takayuki Onishi1, Gilbert H L Tang2, Barry Love1
1Mount Sinai Fuster Heart Hospital, New York, New York, USA.
Objective:
To demonstrate transcatheter aortic valve-in-valve replacement in a small surgical bioprosthesis with a kinked aortic root graft using an intra-annular self-expanding valve.
Key Steps:
Balloon valve fracture to enable implantation of a larger balloon-expandable valve was excluded because of prior root replacement. A supra-annular self-expanding valve with a single-spine shaft was considered unfavorable for the kinked aortic graft. A 23-mm Navitor Vision valve was successfully deployed over a Lunderquist guidewire, with pre- and postdilatation using a 21-mm True balloon.
Potential Pitfalls:
Use of a small balloon-expandable valve could have resulted in unfavorable hemodynamics and increased risk of valve dislodgement during advancement of a naked valve across the kinked aortic graft. A supra-annular self-expanding valve with a single-spine shaft could have posed difficulty crossing the kinked graft in the small surgical bioprosthesis.
Take-Home Message:
A small degenerated surgical bioprosthesis with a kinked aortic graft can be successfully treated with an intra-annular self-expanding valve.
