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requiring coronary angiography and/or PCI as well as redo-TAVI is expected to increase. Therefore,
preserving a manageable coronary re-access after TAVI is becoming a priority in the management of these
patients. The ability to traverse a THV to access the coronary ostia is related to anatomic factors (coronary
height, STJ height, and width) and valve-related features. Self-expanding platforms may present technical
challenges due to their supra-annular position above the coronary ostia, closed-cell frame design, and
asymmetrical skirt. Modified delivery system insertion techniques have been linked to better commissural
alignment and less coronary overlap with self-expandable THVs, but further studies are needed to confirm
and improve their reproducibility. Conversely, balloon-expandable valves, given their low frame height with
sub-coronary implantation and large-cell frame design, generally ensure easier coronary ostium cannulation
despite commissural misalignment. However, commissural alignment is helpful in all THV platforms for
redo-TAVI, especially when the risk plane is above the coronary ostia and even STJ, risking sinus
sequestration and coronary obstruction with redo-TAVI. An individualized decision-making approach is
recommended in device selection and sizing when considering future coronary access and redo-TAVI.

DECLARATIONS
Author contributions
Drafted and revised the manuscript: Avvedimento M
Drafted and revised the manuscript and approved the final manuscript: Tang GHL

Availability of data and materials
Not applicable.

Financial support and Sponsorship
None.

Conflict of Interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2022.

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