during PCR London Valve 2016
Roberto Nerla – Fausto Castriota – Alberto Cremonesi
77 years old male with previous aortic valve replacement (MItroflow n.23 2009) presenting with significant bioprosthesis degeneration (severe stenosis and moderate aortic regurgitation).
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.
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 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.