Coronary obstruction following transcatheter aortic valve-in-valve implantation for failed surgical bioprostheses.

Transcatheter aortic valve implantation (TAVI) for failed surgical bioprostheses, or "valve-in-valve" implantation, is a therapeutic option for high-risk patients. While coronary occlusion during TAVI for native aortic stenosis has been described, in the setting of valve-in-valve implantation the bioprosthetic posts may be protective against this complication. We describe the first two cases of coronary occlusion following valve-in-valve therapy, both occurring during treatment of degenerated Mitroflow bioprostheses. Aortic root anatomy, coronary ostial position, and the specifics of the bioprosthetic valve type need to be considered in assessing and preventing this rare complication.