Subclinical Delayed Coronary Ostial Obstruction After Transcatheter Aortic Valve Replacement With a High-Frame Transcatheter Valve.

We herein describe 2 cases of subclinical delayed coronary obstruction following transcatheter aortic valve replacement. Two female patients (74 and 83 years of age) were admitted to our department with acute heart failure due to severe valvular dysfunction of the transcatheter heart valves (THVs), which had been implanted 38 and 24 months earlier (ACURATE neo). During THV explantation and surgical aortic valve replacement, a massive circumferential endothelial growth around the upper crown of the THV prostheses was observed, leading to sequestration of the sinus of Valsalva with subclinical delayed coronary ostial obstruction. These 2 cases demonstrate a rare but serious complication of the ACURATE neo THV, highlighting the importance of THV prosthesis selection and implantation technique. In the light of lifetime management for aortic stenosis and increasing use in younger and lower risk patients, optimal implantation technique and appropriate THV selection are crucial for patients with small aortic roots, narrow sinuses of Valsalva, and low coronary ostia.