Structural Valve Deterioration of a Subcoronary Implanted Stentless Bioprosthesis: How to Treat?

We present a case of transcatheter valve-in-valve replacement performed because of structural valve deterioration of a subcoronary implanted stentless aortic bioprosthesis. A 23-mm self-expandable transcatheter heart valve (THV) with supraannular seating was chosen. The procedure was performed with the patient under conscious sedation. After anchoring and partial valve deployment, the patient experienced an acute onset of angina. The angiogram showed left main coronary artery obstruction. Prompt resheathing and retrieval of the THV was performed, and the procedure was aborted. Subsequently, an open-heart redo operation was performed by the use of a sutureless aortic bioprosthesis, with satisfactory hemodynamic and clinical results.