Chimney technique in a TAVR-in-TAVR procedure with high risk of left main artery ostium occlusion
A Dibie, Q Landolff, A Veugeois et al.

KEYWORDS
clinical case; chimney technique; TAVR-in-TAVR procedure; left main artery ostium occlusion

An 87-year-old woman was referred to our centre for a valve-in-valve transcatheter aortic valve replacement (TAVR). She underwent a TAVR procedure with implantation of a SAPIEN XT 26 mm (Edwards Lifesciences) bioprosthesis 7 years before but subsequently developed symptomatic aortic valve failure (mean gradient = 64 mmHg).

Pre-procedural computed tomography (CT) scan identified a low height between the valvular plane and left main coronary artery (LMA) ostium equal to 2.7 mm (Panel A₁). Valve simulation technique was applied: the virtual transcatheter heart valve/coronary distance was measured at 4.0 mm (Panel A₂). The coronary angiography revealed no recurrent stenosis (Panel B)....