Reoperation-Sparing Transcatheter Aortic Valve Replacement After Acute Failed Valve-Sparing Aortic Root Replacement.

Transcatheter aortic valve replacement (TAVR) is rarely performed for pure aortic insufficiency. When aortic insufficiency occurs in the context of a prior valve-sparing aortic root replacement (VSARR), the anatomic complexity of performing TAVR is significantly increased. We report a case of successful TAVR deployment in a patient with severe aortic insufficiency soon after VSARR. TAVR deployment in a prior VSARR graft relies on positioning the valve between the running sinus suture line superiorly and in this case CorKnots inferiorly using an oversized balloon-expandable valve to limit paravalvular leak. This was successfully performed with no residual regurgitation. Nonoperative management using TAVR for high-risk surgical candidates can be safely performed for aortic insufficiency after failed VSARR in the acute setting. Proper sizing, valve selection, and positioning are of utmost importance in this setting although the presence of CorKnots used during VSARR may aid in optimal positioning.