In Vitro Assessment of Coronary Perfusion after Valve-in-Valve Transcatheter Aortic Valve Implantation in a High-Risk Patient-Specific Experimental Model.

Coronary obstruction following transcatheter aortic valve-in-valve implantation (VIV-TAVI) carries a high mortality risk. This in-vitro study assessed coronary perfusion in a high-risk VIV-TAVI scenario. A patient deemed at high-risk and treated with preventive Chimney stenting was selected as case study. A 3D-printed aortic root model was fabricated from pre-operative imaging and used to replicate the patient's VIV-TAVI setting. A CoreValve-Evolut-23 was implanted within a Trifecta-19 at five depths, with commissural alignment and 60° misalignment, to explore procedural variability and associated risk margins. The model was tested in a pulsatile mock loop with a coronary perfusion simulator. Flow and pressure were recorded pre- and post-VIV-TAVI under physiological conditions. Across all tested configurations, VIV-TAVI didn't significantly impair left or right coronary flows. The recommended depth optimized hemodynamic valve performance. Findings suggest refining coronary obstruction risk stratification in VIV-TAVI to improve decision-making regarding preventive interventions.