title: High-risk Trans-Catheter Aortic Valve Replacement in a Failed Freestyle Valve with Low Coronary Height: A Case Report.
abstract: A 55-year-old male with a history of two prior cardiac surgeries presented with decompensated heart failure due to severe bioprosthetic aortic valve insufficiency. A third operation was viewed prohibitively high risk and valve-in-valve trans-catheter aortic valve replacement was considered. There were however several high-risk features and technically challenging aspects including low coronary ostia height, poor visualization of the aortic sinuses, and difficulty in identification of the coplanar view due to severe aortic insufficiency, and a highly mobile aortic valve mass. After meticulous peri-procedural planning, trans-catheter aortic valve replacement was carried out with a SAPIEN 3 balloon-expandable valve without any complication. Strategies undertaken to navigate the technically challenging aspects of the case are discussed.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Ashkan
authors.identifier: http://orcid.org/0000-0002-5419-3931
authors.initials: A
authors.lastname: Karimi
authors.affiliation: Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, VA, USA.
authors.forename: Negiin
authors.initials: N
authors.lastname: Pourafshar
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: George
authors.initials: G
authors.lastname: Dibu
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Beaver
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA. anthony.bavry@va.gov.|North Florida/South Georgia Veterans Health System, Gainesville, FL, USA. anthony.bavry@va.gov.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Bavry
keywords: Bioprosthesis; Edwards SAPIEN 3 valve; Freestyle aortic root; Trans-catheter aortic valve replacement; Valve-in-valve