Practical Approach to Transcatheter Aortic Valve Implantation and Bioprosthetic Valve Fracture in a Failed Bioprosthetic Surgical Valve

Figure 3

Preprocedural CT planning in a 91-year-old female patient with high-grade aortic stenosis (peak gradient 64 mmHg and mean gradient 35 mmHg) that underwent ViV-TAVI in a failed 21 mm Epic bioprosthesis. (a) The basal ring of the Epic valve is marked at the center of the cusps (red, blue, and green dots). The stent diameter is 19 mm, and true internal diameter is 16.4 mm (17 mm according to the aortic ViV app, with internally mounted leaflets). (b) The posts of the stent of the Epic valve are marked with generic markers (blue). The blue circle is centered on the surgical valve and represents the waist of the planned 23 mm Evolut valve. The distance between the virtual 23 mm valve (with the waist of 20 mm) and the left coronary (virtual transcatheter valve-to-coronary ostium distance, VTC) is low (3.3 mm). (c) Hockey puck view showing the generic blue markers on the top posts, while the colored markers are in the middle of the cusps at the base of the surgical valve. (d) Coplanar view with the left coronary cusp at the right side (red marker). (e) Cusp-overlap view with overlapping left and right coronary cusps (red and green markers). (f) Low left coronary height (8.5 mm) with shallow sinuses of Valsalva.

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