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Novel TSURECOMI Bailout Technique for Transcatheter Heart Valve Implantation After Accidental Wire Withdrawal During TAVR.

ABSTRACT: This study introduces a case in which our novel "Transarterial Snare-Upholding REcovery technique for COMpletely pulled out LV wire for TAVR valve Insert system (TSURECOMI) technique" with snares was successfully performed for bailout of a transcatheter heart valve during transcatheter aortic valve replacement. (Level of Difficulty: Advanced.).

SUBMITTER: Tanaka A

PROVIDER: S-EPMC8387829 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Simple bailout technique using a snare catheter for wire withdrawal during balloon-expandable transcatheter aortic valve implantation: a case report

Project description:Abstract Background In transcatheter aortic valve implantation (TAVI) using a SAPIEN3 balloon-expandable valve (S3), wire withdrawal from the left ventricle (LV) during the procedure before deployment can induce vascular injury in the access site or require surgical treatment when an S3 removal is attempted. We present a successful case of bailout from this situation safely with a minimally invasive technique using a 6-F snare catheter (SC). Case summary An 86-year-old woman with severe aortic stenosis underwent trans-femoral TAVI using an S3 under conscious sedation. After a pre-shaped wire was inserted into the LV from the right femoral artery, the LV wire was accidentally withdrawn completely from the LV before deployment. Wire re-insertion using a soft straight wire through the tip lumen of the S3 was hindered because the wire orientation was uncontrollable. Hence, we used a 6-F SC to control the wire direction by changing the orientation of the S3. Catching the tip of the S3 with an SC at the ascending aorta enabled us to control the wire direction, and wire re-insertion in the LV with the soft wire was successful. Furthermore, the SC worked well in advancing the S3 through the aortic valve to enhance co-axiality without aortic root injury. The S3 was successfully advanced through the aortic valve and implanted at an optimal position without complications. Discussion Our simple technique using a 6-F SC is technically effective, feasible, and minimally invasive and can be an option for bailout from accidental LV wire withdrawal during balloon-expandable valve TAVI.

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Case report: Buddy wire technique to facilitate atrial septal crossing during transcatheter transseptal mitral valve implantation.

Project description:BackgroundTranscatheter mitral valve-in-valve implantation (MVIV) has emerged as a viable treatment option in patients at high risk for surgery. Occasionally, despite appropriate puncture location and adequate dilation, difficulty is encountered in advancing the transcatheter heart valve across interatrial septum.Case summaryWe describe a case of a 79-year-old woman with severe chronic obstructive pulmonary disease (COPD), prior surgical bioprosthetic aortic and mitral valve replacement implanted in 2007, atrial fibrillation, and Group II pulmonary hypertension who presented with progressively worsening heart failure symptoms secondary to severe bioprosthetic mitral valve stenosis and moderate-severe mitral regurgitation. Her symptoms had worsened over several months, with multiple admissions at other institutions with treatment for both COPD exacerbation and heart failure. Transoesophageal echocardiogram demonstrated preserved ejection fraction, normal functioning aortic valve, and dysfunctional mitral prosthesis with severe stenosis (mean gradient 13 mmHg) and moderate-severe regurgitation. After a multi-disciplinary heart team discussion, the patient underwent a transcatheter MVIV implantation. During the case, inability in advancing the transcatheter heart valve (THV) across interatrial septum despite adequate septal balloon pre-dilation was successfully managed with the support of a stiff 'buddy wire' anchored in the left upper pulmonary vein using the same septal puncture. The patient tolerated the procedure well and was discharged home.DiscussionOperators should be aware of potential strategies to advance the THV when difficulty is encountered in crossing the atrial septum despite adequate septal preparation. One such strategy is the use of stiff 'buddy wire' for support which avoids the need for more aggressive septal dilatation.

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The rescue snared wire technique for challenging transcatheter pulmonary valve implantation: a case series of two patients.

Project description:BackgroundTranscatheter pulmonary valve implantation (TPVI) is an effective treatment for right ventricular outflow tract (RVOT) dysfunction. Patients affected by congenital heart disease requiring TPVI may have difficult anatomies, thus making the intervention technically demanding.Case summaryWe report a case series of two patients affected by RVOT dysfunction. Both the cases were characterized by difficulty to advance the valve over the wire, which was successfully overcome by the application of the snared wire technique (SWT) to TPVI.DiscussionVarious technical pitfalls and tips have been described to facilitate the delivery of the transcatheter Edwards Sapien valve in the pulmonary position. The SWT described by the authors may be a helpful tool to gain supportiveness and stability of the guidewire during the procedure.

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"Cusp-overlap" technique simplifies the implantation of Chinese domestic transcatheter valve in transcatheter aortic valve implantation.

Project description: Not available

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Coronary protection using a pressure wire during transcatheter aortic valve implantation.

Project description:Coronary obstruction is a rare but life-threatening complication of transcatheter aortic valve implantation (TAVI). This article describes the case of a patient with severe aortic valve stenosis treated with TAVI, during which preventive coronary wiring using a pressure wire was performed for coronary protection. After the deployment of the transcatheter heart valve (THV), the values of the fractional flow reserve (FFR) and resting full-cycle ratio (RFR) remarkably decreased, although the findings of transesophageal echocardiography and coronary angiography did not suggest coronary obstruction. Intravascular ultrasound revealed severe stenosis in the left main trunk due to the displacement of the calcified native leaflets. The decrease in the FFR and RFR values after THV deployment led to a diagnosis of partial coronary obstruction, and percutaneous coronary intervention was successfully performed. In patients at a high risk for coronary obstruction, coronary protection with a pressure wire is useful for the diagnosis and prevention of coronary flow deterioration during TAVI. Functional assessment using a pressure wire before and after TAVI may contribute to the accurate diagnosis of coronary obstruction.Learning objectiveAccurate diagnosis of coronary obstruction during transcatheter aortic valve implantation (TAVI) is important for successful management. In patients at a high risk for coronary obstruction, coronary protection with a pressure wire is useful for the diagnosis and prevention of coronary flow deterioration during TAVI. The remarkable decrease in the fractional flow reserve and resting full-cycle ratio values after the deployment of the transcatheter heart valve may suggest coronary obstruction.

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Repeated transcatheter aortic valve implantation for the treatment of a degenerated transcatheter aortic valve implantation valve (valve-in-valve technique): a case report.

Project description:BackgroundValve-in-valve transcatheter aortic valve implantation (TAVI) has emerged as a competent alternative for the treatment of degenerated bioprosthetic valves after surgical aortic valve replacement, or during TAVI procedure as a bailout option. Herein, we report a rare case of a self-expandable Medtronic Evolut R valve into a failing Medtronic CoreValve, with the use of modern pre-TAVI imaging screening, suggesting the proper procedural design steps for so complicated implantations.Case summaryA frail 78-year-old woman with a degenerated Medtronic Core Valve 26 mm bioprosthesis, implanted in 2011 due to severe aortic stenosis, was referred to our hospital due to worsening dyspnoea New York Heart Association III. The screening echocardiography documented severe aortic stenosis, while the classical risk scores were in favour of repeated TAVI (EuroSCORE II 5.67%). Computed tomography measurements and three-dimensional (3D) printing model were of great help for the proper valve selection (Medtronic Evolut R 26 mm), while the use of cerebral protection device (Claret Sentinel) was considered as a necessary part of the procedure. The simultaneous use of fluoroscopy and transoesophageal echocardiogram led to optimal haemodynamic result, confirmed by the discharge echocardiogram, with a significant clinical improvement during the first month follow-up.DiscussionThe main periprocedural concerns remain valve malpositioning, coronary artery obstruction, and high remaining transvalvular gradients. The multimodality pre-TAVI imaging screening may be helpful for precise procedural design. Despite the limited use of 3D models, it is necessary to adopt such tissue-mimicking phantoms to increase the possibility of optimal procedural result.

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Transoesophageal echocardiography-guided wire technique for crossing a stenosed aortic valve during transcatheter aortic valve replacement.

Project description: Not available

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Local versus general anesthesia for transcatheter aortic valve implantation (TAVR)--systematic review and meta-analysis.

Project description:BackgroundThe hypothesis of this study was that local anesthesia with monitored anesthesia care (MAC) is not harmful in comparison to general anesthesia (GA) for patients undergoing Transcatheter Aortic Valve Implantation (TAVR).TAVR is a rapidly spreading treatment option for severe aortic valve stenosis. Traditionally, in most centers, this procedure is done under GA, but more recently procedures with MAC have been reported.MethodsThis is a systematic review and meta-analysis comparing MAC versus GA in patients undergoing transfemoral TAVR. Trials were identified through a literature search covering publications from 1 January 2005 through 31 January 2013. The main outcomes of interest of this literature meta-analysis were 30-day overall mortality, cardiac-/procedure-related mortality, stroke, myocardial infarction, sepsis, acute kidney injury, procedure time and duration of hospital stay. A random effects model was used to calculate the pooled relative risks (RR) with 95% confidence intervals.ResultsSeven observational studies and a total of 1,542 patients were included in this analysis. None of the studies were randomized. Compared to GA, MAC was associated with a shorter hospital stay (-3.0 days (-5.0 to -1.0); P = 0.004) and a shorter procedure time (MD -36.3 minutes (-58.0 to -15.0 minutes); P <0.001). Overall 30-day mortality was not significantly different between MAC and GA (RR 0.77 (0.38 to 1.56); P = 0.460), also cardiac- and procedure-related mortality was similar between both groups (RR 0.90 (0.34 to 2.39); P = 0.830).ConclusionThese data did not show a significant difference in short-term outcomes for MAC or GA in TAVR. MAC may be associated with reduced procedural time and shorter hospital stay. Now randomized trials are needed for further evaluation of MAC in the setting of TAVR.

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