Management of TAVI Candidates With Metal Allergy: Minimally Invasive Aortic Valve Replacement With a Metal-Free Bioprosthesis

An 87-year-old woman with severe aortic stenosis required intervention. Patch testing demonstrated nickel and cobalt hypersensitivity, ruling out transcatheter valve implantation. After multidisciplinary review, minimally invasive aortic valve replacement through a right anterior thoracotomy was chosen, thereby avoiding median sternotomy and stainless steel wires. A 21-mm Avalus bioprosthesis (Medtronic)—engineered without a metallic stent—was implanted successfully. Recovery was smooth. Extubation occurred within hours, and the patient was discharged from the hospital on postoperative day 5. At 1 year, prosthetic performance and clinical status were excellent. This experience illustrates a practical path when transcatheter treatment is contraindicated by documented metal allergy: minimally invasive surgery with a metal-free valve.