We report a young female patient with a complex cardiac surgical history that underwent a redo complex aortic valve replacement. In the context of severe AR and dilated LV, we experienced that it is safer to start the LV venting after aortic cross clamping. In this setting NIRS can be, in this particular context, a useful monitoring tool to prevent potential severe neurological damage.

Redo aortic valve surgery for 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 complex annulus enlargement techniques, and can reduce operative time and morbidities. We describe a case where after explanting a failed 19mm St. Jude mechanical aortic valve and further deployment of a 23mm 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.

We report a patient that underwent a redo complex AVR. In the context of severe AR and dilated LV, we experienced that it is safer to start the LV venting after aortic cross clamping. NIRS in this setting can be a useful tool to prevent potential severe neurological damage.