TAVR-in-TAVR and coronary access: importance of preprocedural planning

Introduction

Transcatheter heart valve (THV) degeneration will become increasingly common with the expansion of the indication for transcatheter aortic valve replacement (TAVR) to low-risk younger subjects with longer life expectancy1. Treatment of structural THV degeneration with the implantation of a second THV is feasible, but data on this subject are scant. In particular, there are concerns about the risk of coronary artery obstruction and the possibility of accessing the coronary ostia in case percutaneous coronary artery intervention should be needed in the future2,3,4.

It is crucial to understand the three-dimensional interaction among degenerated THV, coronary ostia and ...