TRANSCATHETER AORTIC VALVE IN VALVE IMPLANTATION IN SEVERE BIOPROSTHETIC AORTIC VALVE DISFUNCTION AFTER BIOPROSTHETIC BENTALL OPERATION: THE VALVE TO CORONARY PROBLEM

A 85- year-old man presented with shortness of breath. He had a Bio-Bentall operation (Sorin Mitroflow 23 mm + Intervascular Woven tube graft 26 mm) and coronary implantation 11 years ago. TTE demonstrated severe aortic valve prosthesis regurgitation. The TC scan showed a distance between the anulus of the aortic valve and the left coronary (VTC) of 1.7 mm with a high risk of coronary obstruction. The TEE showed a VTC > 6 mm. The patient underwent TAVI VIV via transfemoral approach. There was marked movement of valve marker in relation to sewing ring during systole and diastole, but this was stabilized using rapid pacing, allowing safe and slow deployment of a size 23 mm Evolut PRO self-expanding transcatheter aortic valve. Good valve positioning and no coronary obstruction were confirmed with contrast fluoroscopy. The patient was well post-procedure and discharged 48 h later.