Valve-in-valve TAVI

"Emergency LM PCI with 'chimney technique' to treat coronary artery occlusion after valve-in-valve TAVI"
Awarded as one of the top 5 cases

during PCR London Valve 2016

Roberto Nerla – Fausto Castriota – Alberto Cremonesi

Patient description:

77 years old male with previous aortic valve replacement (MItroflow n.23 2009) presenting with significant bioprosthesis degeneration (severe stenosis and moderate aortic regurgitation).

Initial situation:

Basal aortogram showing the presence of a shallow left coronary sinus with low origin of left main indicating a high risk of coronary occlusion. For this reason, a repositionable device (Lotus valve) was chosen for valve-in-valve TAVI.

Procedure

Valve-in-valve TAVI

Procedure description:

A Lotus 23 mm valve was successfully deployed with no residual leak and no gradient.

However, 90 minutes later cardiac arrest occurred; the aortogram revealed left main occlusion.

After putting a wire in the left cusp to stabilize the guidling catheter (look the video below), two drug-eluting stents were deployed according to the ‘chimney technique‘, that we described for the first time (published by PCRonline on Twitter) as the translation of a peripheral strategy to secure renal arery patency after EVAR to valve-in-valve procedures.

Final results:

Final results showing normal flow into left main. The patient was safely discharged without any complication. He had an angiogram at 6-month follow-up confirming the patency of left main and the good result of valve-in-valve procedure.

Categories: Clinical Cases

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