Transseptal strategy in retrograde transcatheter valve‐in‐valve implantation for failed surgical aortic bioprosthesis

We report a challenging case of transcatheter aortic valve‐in‐valve implantation in an elderly patient with failed surgical bioprosthesis. The transthoracic echocardiogram demonstrated a severe stenosis with a peak gradient of 142 mm Hg. The patient was a high‐risk candidate for reoperative valve replacement; therefore, transfemoral implantation of a CoreValve (Medtronic Inc, Minneapolis, MN) was decided. During the procedure, we were unable to introduce the delivery catheter system across the bioprosthesis due to its poor alignment with the aortic annulus and the severity of the stenosis. With strategies involving transseptal puncture and externalization of a guidewire in an antegrade manner, the CoreValve was successfully positioned and deployed. This case illustrated the utility of transseptal strategies in challenging retrograde transcatheter aortic valve‐in‐valve implantation. © 2013 Wiley Periodicals, Inc.