Scissors-Based Leaflet Modification to Prevent Coronary Obstruction in Valve-in-Valve Transcatheter Aortic Valve Replacement: The EXCALIBUR Technique—A Case Report

Journal of the Society for Cardiovascular Angiography & Interventions, pp. 105517

Abstract

An 81-year-old woman with a degenerated surgical aortic bioprosthesis and high predicted risk of coronary obstruction underwent valve-in-valve transcatheter aortic valve replacement. Preprocedural imaging showed low coronary ostial height and unfavorable sinus anatomy. To mitigate this risk, we performed Ensizor eXCision of Aortic Leaflets In Bioprostheses at Unacceptable coronary occlusion Risk, a novel mechanical leaflet modification technique using a scissor-based catheter system. Both bioprosthetic leaflets were successfully split under imaging guidance, with immediate regurgitation confirming effective modification. Subsequent valve implantation was uneventful, with preserved coronary flow on final imaging. This case illustrates the feasibility of a controlled mechanical approach to prevent coronary obstruction during high-risk valve-in-valve procedures.

Authors 5

1. José M. Montero Cabezas corresponding Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology , Leiden University Medical Center , Leiden , the Netherlands

2. Madelien Veronique Regeer Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology , Leiden University Medical Center , Leiden , the Netherlands

3. Adan Gomez-Ramirez Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology , Leiden University Medical Center , Leiden , the Netherlands

4. Nina Ajmone-Marsan Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology , Leiden University Medical Center , Leiden , the Netherlands

5. Frank van der Kley Aachen Department of Cardiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Cardiology , Leiden University Medical Center , Leiden , the Netherlands