Strategic Transcatheter Aortic Valve Replacement in Patients With Protruding Left Coronary Artery Stents

BACKGROUND: Transcatheter aortic valve replacement is challenging in patients with coronary artery stents protruding into the aorta. While there have been a few reports using balloon-expandable valves with unique techniques, there are no reports using self-expandable valves (SEVs). CASE SUMMARY: A 94-year-old man with a protruding left main tract stent into the aorta underwent transcatheter aortic valve replacement with SEV, taking into consideration the interference with the coronary artery ostium. Through coronary artery protection and postdilatation of the coronary ostium, the transcatheter heart valve (THV) was able to be safely implanted and coronary blood flow was preserved, although the commissure tab of the THV was in close proximity to the coronary ostium. DISCUSSION: The cell size and the commissure alignment of the THV are of particular concern when implanting SEVs in patients with protruding coronary stent. TAKE-HOME MESSAGE: SEV implantation can be a safe option in patients with protruding coronary stents.