The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

TAVR-in-TAVR and Coronary Access: The Importance of Pre-procedural Planning

DOI: 10.4244/EIJ-D-19-01094

1. Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy, Italy
2. Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua, Italy.
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Transcatheter heart valve (THV) degeneration will be increasingly common with the expansion of transcatheter aortic valve replacement (TAVR) indication 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 to access the coronary ostia in case percutaneous coronary artery intervention will be needed in the future2-4.

It is crucial to understand the 3-dimensional interaction among degenerated THV, coronary ostia and aortic root to guide pre-procedural planning of TAVR-in-TAVR with the aim to minimize the risk of acute coronary artery occlusion and preserve future coronary access (CA). In fact, the implantation of a second THV will tilt up the leaflets of the previously implanted device, thereby creating a covered cylindric stent tall as the commissural posts.

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