A case of challenging percutaneous coronary intervention following surgical aortic valve replacement with a sutureless aortic bioprosthesis.

A 71-year-old man with symptomatic severe aortic valve stenosis and stenosis of the proximal right coronary artery (RCA) underwent aortic valve replacement with Perceval (LivaNova, London, UK), a sutureless aortic bioprosthesis with a self-expanding open-cell designed nitinol frame (SL-AVR). Seven weeks after the SL-AVR, percutaneous coronary intervention (PCI) to the RCA was required. However, engagement of the guiding catheter (GC) was challenging because the RCA ostium was jailed by the strut of the Perceval. Therefore, the "Mother, Child, and Grandchild Technique" was used. A 4-Fr diagnostic catheter (DC) was partially engaged, and a support type 0.014-inch guidewire (GW) was inserted into the distal RCA. The DC was replaced by a 6-Fr GC. To fill the gap between the 0.014-inch GW and 6-Fr GC, a 5-Fr tapered inner sheath (IS, tip size was 3.0-Fr, used as Child catheter) was inserted into the 6-Fr GC (Mother catheter), and a 2.6-Fr microcatheter (Grandchild catheter) was inserted into the 5-Fr IS. Therefore, the gap between the 0.014-inch GW and 6-Fr GW was obliterated. Finally, we successfully inserted the PCI system and engaged the GC. RCA stenosis was treated using the conventional PCI technique. Herein, we report a case of successful PCI subsequent to SL-AVR. <