Trilogy Transcatheter Aortic Valve Implantation for Freestyle Graft With Flail Left Coronary Cusp

CASE SUMMARY: This clinical vignette describes successful transcatheter aortic valve implantation (TAVI) in a Freestyle graft with a flail left coronary cusp using a 27-mm Trilogy valve (JenaValve Technology). Using a Trilogy valve in cases with a flail cusp raises concerns of insufficient valve sealing and stability; our report demonstrates the feasibility and safety of the procedure with excellent procedural outcomes. TAKE-HOME MESSAGES: TAVI using the Trilogy valve for degenerated Freestyle graft with flail left coronary cusp is feasible, with several advantages over commercially available TAVI platforms. However, additional cases are required to demonstrate its safety and reproducibility.