High-risk trans-catheter aortic valve replacement in a faile
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A 55-year-old male with a history of two prior cardiac surgeries presented with decompensated heart failure due to severe bioprosthetic aortic valve insufficiency. A third operation was viewed prohibitively high risk and valve-in-valve trans-catheter aortic valve replacement was considered. There were, however, several high-risk features and technically challenging aspects including low coronary ostia height, poor visualization of the aortic sinuses and difficulty in identification of the coplanar view due to severe aortic insufficiency and a highly mobile aortic valve mass. After meticulous peri-procedural planning, trans-catheter aortic valve replacement was carried out with a SAPIEN 3 balloon-expandable valve without any complication...

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