Valve-in-Valve Transcatheter Aortic Valve Replacement Using the Triton Technique: A Case Report

Authors

• Arturo Giacaman Saavedra, Henry Ford HealthFollow
• Pedro Engel Gonzalez, Henry Ford HealthFollow
• Brian P. O’Neill, Henry Ford HealthFollow
• James Lee, Henry Ford HealthFollow
• Georgi Fram, Henry Ford HealthFollow
• Bryan Zweig, Henry Ford HealthFollow
• John Dawdy, Henry Ford HealthFollow
• Tiberio M. Frisoli, Henry Ford HealthFollow
• Pedro Villablanca, Henry Ford HealthFollow

Recommended Citation

Giacaman A, Engel Gonzalez P, O’Neill BP, Lee J, Fram G, Zwieg B, Dawdy J, Frisoli T, Villablanca P. Valve-in-Valve Transcatheter Aortic Valve Replacement Using the Triton Technique: A Case Report. J Soc Cardiovasc Angiogr Interv. 2026.

Document Type

Article

Publication Date

6-3-2026

Publication Title

J Soc Cardiovasc Angiogr Interv

Abstract

Coronary artery obstruction is a rare but life-threatening complication of valve-in-valve transcatheter aortic valve replacement, particularly in patients with externally mounted leaflet bioprostheses and high-risk computed tomography features. We report the case of a 77-year-old woman with a degenerated 23-mm Mitroflow valve (Sorin Group Inc) and severe aortic regurgitation who was deemed extreme risk for redo surgery. Because BASILICA was not feasible due to heavily calcified leaflets, valve-in-valve transcatheter aortic valve replacement with a 20-mm SAPIEN 3 Ultra (Edwards Lifesciences) was performed with simultaneous bilateral coronary chimney stent deployment (TRITON technique). The procedure was successful, with preserved coronary flow, excellent valve function, and an uncomplicated clinical course at 6-month follow-up. This case illustrates a feasible rescue/preventive strategy for selected patients at prohibitive risk of coronary obstruction when leaflet modification is not possible.