Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become a first-line treatment for elderly patients with severe aortic stenosis since its first successful implementation in 2002. However, performing TAVR in patients with extreme horizontal heart orientation and acute aortic angulation is technically challenging and carries higher procedural risks. CASE SUMMARY: This case report describes a patient with severe aortic stenosis complicated by an extreme horizontal heart position and acute aortic angulation. Under the support of cardiopulmonary bypass (CPB), femoral artery long sheaths, and snare traction, the TAVR procedure was successfully completed. DISCUSSION: The success of this case provides valuable insights for managing complex TAVR procedures. TAKE-HOME MESSAGES: CPB provides critical hemodynamic support during TAVR in patients with extreme horizontal cardiac orientation, effectively preventing intraoperative circulatory collapse. Advancing a femoral artery long sheath combined with snare traction overcomes challenges when TAVR in cases of severe horizontal heart orientation and acute aortic angulation.