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Chimney technique in a TAVR-in-TAVR procedure with high risk of left main artery ostium occlusion Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis Usefulness of intravascular ultrasound guidance in percutaneous coronary intervention with second-generation drug-eluting stents for chronic total occlusions (from the Multicenter Korean-Chronic Total Occlusion Registry) Discrepancies in Measurement of the Thoracic Aorta: JACC Review Topic of the Week Intravascular Ultrasound Assessment of In-Stent Restenosis in Saphenous Vein Grafts Long-term effects of intensive glucose lowering on cardiovascular outcomes Meta-Analysis of Effectiveness and Safety of Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement in Low-to-Intermediate Surgical Risk Cohort 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines Impact of Lesion Preparation Strategies on Outcomes of Left Main PCI: The EXCEL Trial Intravascular Ultrasound Guidance Is Associated With Better Outcome in Patients Undergoing Unprotected Left Main Coronary Artery Stenting Compared With Angiography Guidance Alone
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Clinical Case Study2020 Nov 14;ehaa817.

JOURNAL：Eur Heart J. Article Link

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

ABSTRACT

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)....

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