Abstract
Abstract Background TAVR-in-TAVR within index supra-annular transcatheter heart valves (THV) and high-risk anatomy can compromise coronary perfusion and re-access. Case Summary An 80-year-old male presented with acute heart failure caused by degeneration of an Evolut R THV, leading to severe aortic regurgitation. Aortic CT imaging revealed a high-risk anatomy characterized by the index THV's commissural plane being placed above the coronary ostia and a valve-to-aorta distance of less than 2 mm, resulting not eligible for redo-TAVR according to recent literature. The current case represents the first-in-human application of redo-TAVR with low SAPIEN 3 THV implantation within an Evolut R THV obtaining index leaflet overhang, preserving coronary perfusion and potential coronary re-engagement. Discussion Following in vitro study, this case demonstrates in vivo feasibility of redo-TAVR with low SAPIEN 3 THV implantation within an Evolut R THV obtaining index leaflet overhang.
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