Effective planning for valve retrieval and coronary protection is essential

T ranscatheter aortic valve replacement (TAVR) is a well-established therapy that has revolutionized the management of patients with severe aortic stenosis who are deemed suboptimal candidates for surgery.1-3 Despite increasing experience with and understanding of the procedure and patient selection, TAVR is still associated with unexpected complications, such as paravalvular aortic regurgitation, conduction disturbances, cardiac perforation, and ostial coronary occlusion. Obstruction of the coronary ostium during a native valve TAVR is relatively infrequent, occurring in < 1% of cases. Left main coronary occlusion is more commonly involved, whereas right coronary artery occlusion rarely happens after valve deployment.4 However, this complication can result in acute hemodynamic collapse and is associated with a high mortality rate.4,5 Therefore, rapid recognition, institution of hemodynamic support, and reestablishment of coronary flow are critical for patient survival.