Oct 20th 2020

Loop Snare Technique to Assist TAVR Crossing of a Difficulty Failed Bioprosthetic Valve

Structural and Valvular

66-year-old female with a history of bicuspid aortic valve and ascending aortic aneurysm s/p 23mm Magna bioprosthetic valve replacement and ascending aortoplasty presented with symptomatic severe prosthetic aortic valve stenosis. She was moderate risk for surgery and suitable candidate for TAVR. Valve-in-valve TAVR procedure was complicated by inability of the valve system to traverse bioprosthetic aortic valve due to a dilated and horizontal ascending aorta and interference between the two prostheses, despite various manipulations and balloon valvuloplasty with 16mm Tyshak® balloon. A unique snare technique was performed and able to successfully facilitate crossing of valve system across aortic valve and allow deployment of 26mm Evolut R® valve without any complications.