Valve-in-Valve Transcatheter Aortic Valve Implantation With Acute Left and Right Coronary Artery Occlusion: A Case Report

Acute coronary artery occlusion is a relatively rare procedural adverse event in valve-in-valve transcatheter aortic valve implantation. Here we present a case of a 26-mm Sapien 3 prosthetic valve implantation in a degenerated 23-mm Freedom Solo bioprosthetic surgical valve with subsequent left and right coronary occlusion. Left coronary artery occlusion was managed immediately with the use of an upfront coronary artery protection technique and drug-eluting stent placement. Right coronary artery occlusion presented with right-sided heart failure and cardiac arrest that required resuscitation and additional hemodynamic support. As the artery could not be engaged with a catheter, a combination of intravenous antithrombotic and anticoagulant therapy was used as a successful bailout step to restore adequate coronary flow.