Novel percutaneous intervention technique for obstructed coronary artery after valve‐in‐valve transcatheter aortic valve replacement

• Published in: Catheterization and cardiovascular interventions Vol. 102; no. 7; pp. 1259 - 1262
• Main Authors: Mitsui, Kentaro, Takagi, Kensuke, Kakuta, Takashi, Noguchi, Teruo
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.12.2023
• Subjects: ACS/NSTEMI; Aged, 80 and over; Aorta; Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Catheters; Coronary artery; coronary artery disease; Coronary Occlusion - surgery; Coronary Vessels - surgery; Female; heart disease; Heart Valve Prosthesis; Humans; Percutaneous Coronary Intervention; Risk Factors; Stenosis; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - methods; Treatment Outcome; valvular; coronary artery disease; ACS/NSTEMI; valvular; heart disease
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.30865

Valve‐in‐valve transcatheter aortic valve replacement (valve‐in‐valve TAVR) increases the risk of coronary obstruction. Although the coronary protection strategy is widely used, the use of the bailout technique after coronary obstruction is limited. Hence, we report a simple bailout technique for coronary obstruction after valve‐in‐valve TAVR. An 82‐year‐old woman presented with structural valve deterioration. The left anterior descending coronary artery had 90% stenosis. After TAVR, the prosthetic valve shifted close to the ascending aorta wall, consequently impairing coronary flow. The wire crossed with the Judkins right guiding catheter (JR) reference to the en‐face and perpendicular views. Using the guide‐extension catheter, the JR contacted the contralateral ascending aorta as a backup catheter. After a balloon was dilated between the prosthetic valve and aorta, JR engaged into the coronary artery with excellent backup. This novel “Whisker pole guiding technique” is useful, even after valve‐in‐valve TAVR.