The use of balloon-expandable Sapien-3 valve in redo aortic valve replacement and the potential risk of left main stem occlusion.

Redo aortic valve surgery for the failure of a previously implanted valve is always challenging. In case of small-sized implanted valves, the use of a balloon-expanding Sapien-3 valve can enhance the final effective orifice area, avoid annulus enlargement complex techniques, and can reduce operative time and morbidities. We describe a case where after explanting a failed 19 mm St. Jude mechanical aortic valve and further deployment of a 23 mm Sapien-3 valve, the left coronary ostia was obstructed by the skirt of the transcatheter prosthesis. After careful removal of a little part of the skirt, we were able to restore the coronary flow and the patient had a favorable outcome.