# Procedural Risk Associated With Anomalous Coronary Artery Supply During Aortic Valve Replacement

## TL;DR

This paper discusses the increased risk of TAVR in patients with unusual coronary artery anatomy and highlights the importance of surgical planning in such cases.

## Contribution

The paper presents a novel case of aortic valve replacement in a patient with an anomalous coronary artery supply and emphasizes the need for pre-procedural planning.

## Key findings

- Anomalous coronary artery supply increases procedural risk in TAVR.
- SAVR allows direct visualization and protection of anomalous coronary ostia.
- Pre-procedural catheterization is crucial for patients with atypical coronary anatomy.

## Abstract

Aortic stenosis (AS) is a common valvular heart disease in the elderly population. Transcatheter aortic valve replacement (TAVR) is a preferred modality for severe symptomatic AS management in elderly patients with high surgical risk. However, unusual coronary artery supply with anatomical variations may increase the procedural risk in TAVR, making surgical aortic valve replacement (SAVR) a suitable modality. This article presents a case of a 77-year-old male with severe symptomatic AS with an uncommon coronary anomaly where all three major coronary arteries originate from the right coronary sinus, posing a high risk for coronary obstruction during TAVR. The SAVR procedure was performed successfully, allowing for direct visualization and protection of the anomalous coronary ostia. This case emphasizes the crucial role of pre-procedural catheterization and surgical planning in patients with atypical coronary artery supply.