Direct Intravascular Observation of Trifecta️ Bioprosthetic Valve Dysfunction Using Nonobstructive General Angioscopy

Although surgical reintervention remains the standard of care for failed surgical valves, transcatheter aortic valve implantation in surgical aortic valves (TAV-in-SAV) has emerged as a viable alternative with reliable results. The Trifecta valve is one of the most challenging SAVR prostheses for TAV-in-SAV management. Recently, nonobstructive general angioscopy (NOGA) has been used to evaluate the quality of plaques on the inner surface of the aorta under direct visualization, which cannot be evaluated using computed tomography. Here, we describe a case of Trifecta️ bioprosthetic valve dysfunction (BVD) directly observed by NOGA. A 26-mm Evolut FX was implanted, and the procedure was completed without complications. This case highlights the potential adjunctive role of NOGA in the assessment of BVD; however, its incremental clinical benefit and safety profile require further investigation.