Transfemoral TAVI with balloon-expandable valve for failing aortic root homografts

To the Editor, The use of cryopreserved homografts as complete aortic root replacements was introduced for the first time over 3 decades ago with considerable advantages with respect to biological heart valves such as greater durability, lower risk of endocarditis, and better hemodynamic profile with a much greater preservation of the ventricular function in the long run.1 However, most of these grafts start degenerating 10 years after being implanted, and they often present with massive calcification of the homograft wall, and valvular dysfunction.2 In this context, surgical reintervention is associated with a very high risk given the need to operate on a heavily calcified aorta that often requires a new and total replacement of the aortic root,3,4 which is why transcatheter aortic valve implantation (TAVI) seems especially appealing. Homograft valves often degenerate presenting with clinically pure aortic regurgitation. Also, the aortic root often shows very extensive calcification at sinus and sinotubular junction level; paradoxically, however, annular calcification is sometimes a rare phenomenon.3,4 This can jeopardize the stability of the balloon-expandable valve. However, to this point, there is scarce scientific evidence on the role it plays in this specific anatomical context. These are the cases of 5 consecutive patients (mean age: 68.4 ± 10.4...