ArticleFrontiers in medicine2026
Case Report: Selective metal cell excision during open TAVR implantation preserves coronary access while maintaining valve integrity and function.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Coronary access following transcatheter aortic valve replacement (TAVR) remains challenging and should be carefully considered when planning re-intervention for patients with structural valve degeneration. Current management options [valve-in-valve (ViV) TAVR or surgical aortic valve replacement and TAVR explant] both carry significant benefits and limitations. Case presentation: A 78-year-old female with a degenerated 23 mm Sapien 3 TAVR presented with severe prosthetic stenosis, moderate paravalvular leak (PVL), and progressive dyspnea. A standard TAVR ViV had a suboptimal risk of not addressing the PVL and worsening prosthesis-patient mismatch, whereas TAVR explantation and SAVR with root enlargement carried an increased surgical risk. Intervention: Open surgical TAVR explantation with direct re-implantation of a 26 mm Sapien Ultra valve, combined with selective metal cells excision facing the left main coronary artery (LMCA) and felt patch repair of the PVL. Outcome: The patient achieved immediate resolution of severe stenosis and elimination of PVL, with sustained clinical improvement at six-month follow-up and a more favorable coronary access. Conclusion: Selective metal cell excision during open TAVR implantation is a technically feasible approach to prophylactically preserve coronary access while maintaining valve integrity and function. This technique may benefit high-risk patients requiring TAVR explants and root enlargement SAVRs.
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