{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T18:47:28Z","timestamp":1769280448418,"version":"3.49.0"},"reference-count":5,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"vor","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background: Valve-in-valve transcatheter aortic valve implantation (ViV TAVI) in small surgical bioprostheses presents unique challenges due to high residual gradients and risk of coronary obstruction.<\/jats:p>\n                  <jats:p>Case summary: We report a case of an 86-year-old man with a degenerated Mitroflow 19 mm valve who underwent ViV TAVI via transcarotid access using a 20 mm Myval valve. Significant underexpansion was observed post-implantation, with elevated transvalvular gradients. Bioprosthetic valve fracture (BVF) was performed using an 18 mm non-compliant balloon, resulting in full valve expansion and gradient reduction. Shortly after BVF, the patient developed myocardial stunning and hemodynamic collapse, requiring urgent veno-arterial extracorporeal membrane oxygenation (VA ECMO) support. Extracorporeal membrane oxygenation was successfully weaned after 48 hours, and the patient was discharged in stable condition.<\/jats:p>\n                  <jats:p>Conclusion: This is the first reported case of transcarotid ViV TAVI with BVF in a 19 mm Mitroflow bioprosthesis, successfully rescued with ECMO. The report highlights the importance of appropriate access planning, valve selection, and ECMO standby in complex high-risk anatomies.<\/jats:p>","DOI":"10.1093\/icvts\/ivaf298","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T12:33:45Z","timestamp":1768566825000},"source":"Crossref","is-referenced-by-count":0,"title":["Breaking the Limits: Transcarotid Valve-in-Valve Transcatheter Aortic Valve Implantation With Bioprosthetic Valve Fracture in a Small Mitroflow and Extracorporeal Membrane Oxygenation Rescue"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1483-9037","authenticated-orcid":false,"given":"V\u00edctor X","family":"Mosquera","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coru\u00f1a , A Coru\u00f1a 15006,","place":["Spain"]},{"name":"Instituto de Investigaci\u00f3n Biom\u00e9dica de A Coru\u00f1a (INIBIC) , A Coru\u00f1a 15006,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 M","family":"Martinez-Comendador","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coru\u00f1a , A Coru\u00f1a 15006,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 J","family":"Cuenca-Castillo","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coru\u00f1a , A Coru\u00f1a 15006,","place":["Spain"]},{"name":"Instituto de Investigaci\u00f3n Biom\u00e9dica de A Coru\u00f1a (INIBIC) , A Coru\u00f1a 15006,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"2026012304321184400_ivaf298-B1","first-page":"1710","article-title":"Balloon fracture of surgical valves in transcatheter valve-in-valve procedures: bench testing and clinical experience","volume":"157","author":"Allen","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026012304321184400_ivaf298-B2","first-page":"1738","article-title":"Bioprosthetic valve fracture improves hemodynamic results in valve-in-valve TAVR","volume":"10","author":"Chhatriwalla","year":"2017","journal-title":"JACC Cardiovasc Interv"},{"key":"2026012304321184400_ivaf298-B3","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/j.athoracsur.2025.01.009","article-title":"Bioprosthetic valve fracture for transcatheter aortic valve-in-valve replacement: a systematic literature review","volume":"120","author":"Chopko","year":"2025","journal-title":"Ann Thorac Surg"},{"key":"2026012304321184400_ivaf298-B4","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1016\/j.jtcvs.2021.04.075","article-title":"Paradigm shifts in alternative access for transcatheter aortic valve replacement: an update","volume":"165","author":"Junquera","year":"2023","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026012304321184400_ivaf298-B5","first-page":"e66964","article-title":"Emergency and prophylactic extracorporeal membrane oxygenation for patients undergoing valve-in-valve transcatheter aortic valve implantation with small surgical bioprosthesis: a report of four cases","volume":"16","author":"Watanabe","year":"2024","journal-title":"Cureus"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivaf298\/66483589\/ivaf298.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/1\/ivaf298\/66483589\/ivaf298.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/41\/1\/ivaf298\/66483589\/ivaf298.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T09:32:25Z","timestamp":1769160745000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivaf298\/8431718"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":5,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,6]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivaf298","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2026,1]]},"article-number":"ivaf298"}}