Preemptive Alcohol Septal Ablation Prior to Valve-in-Valve Transcatheter Mitral Valve Replacement With Bioprosthetic Balloon Fracture

Abstract A 78-year-old woman with bioprosthetic mitral valve degeneration at high risk for reoperation was referred for transcatheter mitral valve replacement. We describe the use of a preemptive alcohol septal ablation pre-procedurally to minimize the risk of acute left ventricular outflow tract obstruction given the anticipated need for a bioprosthetic valve fracture. (Level of Difficulty: Advanced.)