75-year-old female with prior CABG presented with new onset angina and progressive NYHA Class III heart failure for last 6 months. Echo revealed severe AS with planned TAVR. A cardiac cath on July 27, 2021 at time of TAVR procedure revealed patent LIMA to LAD, patent SVG to OM1 and multiple 90% severe calcified RCA lesions. Patient underwent TF-TAVR using a 29mm Evolut Pro+ valve via right percutaneous femoral access with Shockwave lithotripsy of right iliac artery. Patient is now planned for complex PCI of calcified RCA via Evolut TAVR valve struts using rotational atherectomy + IVL (RotaTripsy) and DES.