INTROTUCTION
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of symptomatic severe aortic stenosis (AS) (1). In the last decade, TAVR was approved from inoperable to low surgical risk patients based on the results of landmark randomized trials (2-5). As TAVR indications continue to expand, along with the advancement of devices and technical skills, more patients with poor vascular access or challenging anatomy once considered illegible for TAVR may be attempted.
Because of the physical limitation of currently available transcatheter heart valves (THV) sizes, AS patient with extremely large aortic annulus (ie., area > 683 mm2 or perimeter > 94 mm) is contraindicated for TAVR. However, several case series have demonstrated the feasibility of over-expansion of a 29 mm SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) in patients with aortic annulus area between 683~800 mm2 (6-9). We report the following successful THV implantation in a severe tricuspid AS patient with aortic annulus area >800 mm2, the largest in the literature to the best of our knowledge.