The options for reoperation for a dysfunctional mechanical aortic prosthesis in a small aortic root may be limited for high-risk patients. This report describes a case in which transcatheter aortic valve replacement was used through the open aorta on cardiopulmonary bypass to minimize operative duration and reduce the risk of prosthesis-patient mismatch in a patient who was a Jehovah’s Witness with a failed 17-mm mechanical aortic prosthesis.
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