ViV in a degenerated self-expandable THV and coronary protection using Chimney-Stenting Technique

90-years old female patient with a degenerated transcatheter heart valve (THV) (Acurate neo S) implanted 5 years earlier presented with dyspnea. Echocardiography showed a mean gradient of 72mmHg, moderate aortic insufficiency and 40% ventricle function. Computed tomography (CT) showed low left main height and calcified leaflets of the THV. Transfemoral transcatheter aortic valve implantation (Tf-TAVI) in TAVI. A 20mm Sapien3 Ultra valve was implanted with left main Chimney Stenting technique. Transvalvular mean gradient afterwards was 21mmHg, and CT scan revealed good valve expansion.