ORCID

0000-0001-9627-6236 (Benza), 0009-0005-0864-2686 (Talreja)

Document Type

Article

Publication Date

2026

DOI

10.1016/j.jaccas.2026.108048

Publication Title

JACC: Case Reports

Volume

Advance online publication

Pages

108048

Abstract

Background Retrograde valve crossing during valve-in-valve transcatheter aortic valve replacement (ViV TAVR) may fail despite modern delivery systems. Case Summary A 67-year-old man with a degenerated 27-mm Magna Ease bioprosthesis and unfavorable aortic geometry (kinked ascending aorta at a prior surgical graft site) underwent ViV TAVR, where retrograde valve crossing failed despite multiple stiff guidewires and snare traction alone. Successful delivery of a 29-mm Evolut FX+ was ultimately achieved by combining gooseneck-snare traction for coaxial realignment with a partially inflated Tyshak buddy balloon acting as a mechanical ramp across the surgical valve frame. Discussion This case demonstrates a structured, stepwise approach to managing failed valve crossing in ViV TAVR, highlighting the mechanical roles of snare traction and balloon-mediated coaxial alignment. Take-Home Message A combined snare and buddy-balloon strategy can facilitate valve delivery when conventional retrograde crossing fails during ViV TAVR.

Rights

© 2026 The Authors.

Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC-BY-NC-ND 4.0) License.

Original Publication Citation

Sarfraz, H., Javed, M. U., Parikh, P. K., Cohen, J. A., Benza, R. L., Summers, M. R., & Talreja, D. R. (2026). Combined snare and buddy-balloon strategy for failed valve crossing in valve-in-valve transcatheter aortic valve replacement. JACC: Case Reports. Advance online publication. https://doi.org/10.1016/j.jaccas.2026.108048 

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