**4.5 Post aortic valve replacement coronary intervention**

Supra-annular valves like CoreValve bio prosthetic makes coronary access challenging. The goal is to a use a guide catheter to cross the cells of the bio prosthetic valve at the level of the coronary. Best approach is to use a 0.5 shorter guide catheter than usually used. Wire assisted technique to manipulate the GC to sit within the bio prosthetic and at the appropriate cell level to cross toward the coronary ostium. Manipulating the GC with a 0.035″ guide wire should be performed within the lumen of the aorta and away from the aortic wall to avoid aortic or coronary ostium injury. Guide wire makes the GC stiff and moving the GC quickly could cause the GC to jump quickly and damage the coronary ostium. Once the GC is in a good trajectory and directed toward the coronary ostium, GC should be advanced slowly toward the ostium.
