460 BIOPROSTHESIS HEMODYNAMICS AND CORONARY FLOW AFTER TAVI IN TAVI

Abstract Background TAVI-in-TAVI is a complex intervention, potentially associated with feared complications such as coronary artery obstruction or Sinus of Valsalva (SOV)sequestration. Coronary risk high when the degenerated bioprosthesis has supra-annular leaflets, sinus effaced, and/or sino-tubular Junction (STJ) narrow. Clinical Case A 91 years old man, underwent TAVI Acurate NEO M in 2016 good results: post procedural mean gradient was 8mmHg and PVL mild. He admitted our Institute after six from index procedure for an episode acute heart failure echocardiogram findings prolapse one prosthetic leaflet causing severe aortic regurgitation without signs active endocarditis. potential candidate transfemoral he had intermediate score. The most important phase this careful planning through preprocedural CTA. maximal neoskirt 30mm. In case, on hand, we wide SOV 33mm diameter STJ 30mm diameter, other hand left main ostia height 15.5mm, right 14mm 25mm basal plane transcatheter valve (THV), hence excluded THV higher frame Evolut to prevent formation long-covered stent at least 23-24mm 29-30mm respectively. trasversal annular obtained by multiplanar CT reconstruction implanted “virtual” geometric center simplified cylinder 23 mm measure (VTC) junction (VTSTJ) distance obtaining safe values 5mm 8mm respectively, both above threshold 4mm VTC 2,5-3,5mm VTSTJ. We chose SAPIEN ULTRA 23mm its short 18mm open cell strut facilitate coronaries reaccess cost degree first leaflets overhang. decided perform low implant more percentage overhang but flow impairment. Results Excellent result correct positioning, patency absence leak. selective cannulation performed easily successfully. patient discharged next day stable haemoglobin no intraprosthetic regurgitation. Conclusion case degeneration preserved mobility, implantation could preserve top determining precluding short-term hemodynamics Discussion consideration expansion indication even younger patients will encounter increase procedures, therefore it essential familiarize CTA reconstructions assess direct indirect occlusion do best choice according cause dysfunction anatomical features.