Orthotopic Left Main Chimney Stenting to Prevent Stent Compression After Transcatheter Aortic Valve Replacement

Coronary obstruction (CO) is a severe complication of transcatheter aortic valve replacement (TAVR). An 80-year-old woman presenting with severe aortic stenosis was referred for TAVR. A preprocedural computed tomography revealed risk factors for CO: narrow aortic root and borderline-low coronary height. During TAVR, both coronaries were protected. After transcatheter heart valve (THV) implantation, contrast staining of the left sinus and leaflet interaction with the left main (LM) ostium were noted, prompting LM stenting to prevent obstruction. Because the THV-aorta space was virtual, we opted for rewiring and LM stenting through a THV cell. A postprocedural computed tomograohy revealed a permeable, well-expanded stent. Chimney stenting between the THV and aorta may be unfeasible in patients with a narrow aorta because of a risk of stent compression. Orthotopic chimney stenting through a THV cell may be preferable to classic chimney stenting in patients with a narrow aorta and minimal THV-aorta space.