Transcatheter Aortic Valve Replacement After David Procedure for Severe Aortic Regurgitation

BACKGROUND: Transcatheter aortic valve replacement (TAVR) for aortic insufficiency (AI) after valve-sparing aortic root replacement (VSARR) presents unique anatomical and procedural challenges. CASE SUMMARY: We report successful transfemoral TAVR in a 68-year-old man with severe AI following a prior David procedure. Procedural planning incorporated gated computed tomography assessment of graft dimensions and coronary heights. Device sizing and deployment strategy relied on the left main (LM) ostium as a fluoroscopic landmark and the graft diameter to define the anchoring zone. A balloon-expandable valve was selected with >15% oversizing. The device was deployed successfully without residual regurgitation or coronary obstruction. DISCUSSION: This case highlights the feasibility of TAVR after VSARR with AI and emphasizes the importance of integrating prior surgical technique and graft anatomy into transcatheter procedural planning. TAKE-HOME MESSAGE: Procedural planning using anatomical landmarks may aid in the safe deployment of TAVR in failed VSARR with AI.