Abstract
An 82-year-old patient presented with severe symptomatic aortic stenosis, a high surgical
risk profile, and a history of abdominal aortic replacement. Arterial access vessel
conditions precluded transarterial transcatheter aortic valve implantation (TAVI).
Transcaval access through the aortic graft was achieved; however, tortuosity and resistance
at the graft entry site hampered insertion of the introducer sheath and delivery system.
Transcaval TAVI without a sheath was contemplated with the expectation of aortocaval
fistulous decompression of blood around the TAVI catheter. Hemodynamic measures remained
stable, and the valve was successfully implanted. This case illustrates the feasibility
of sheathless transcaval TAVI without relevant hemodynamic compromise.
Résumé
Un patient âgé de 82 ans présentait une sténose aortique sévère symptomatique, un
profil de risque chirurgical élevé et des antécédents de remplacement de l’aorte abdominale.
L’état des vaisseaux utilisés pour l’abord artériel excluait toute possibilité d’implantation
de valve aortique transcathéter (IVAT) par voie transartérielle. La voie transcave
a été utilisée à travers la greffe aortique; toutefois, la tortuosité et la résistance
au point d’insertion au niveau de la greffe nuisaient à l’insertion de la gaine et
du système de déploiement. Une IVAT par voie transcave sans gaine d’insertion a alors
été envisagée, en anticipant une décompression fistuleuse aorto-cave du sang autour
du cathéter d’IVAT. Les paramètres hémodynamiques sont demeurés stables, et l’implantation
de la valve a réussi. Ce cas illustre la faisabilité d’une IVAT par voie transcave
sans gaine d’insertion et sans compromettre les paramètres hémodynamiques pertinents.
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References
- Transcaval access and closure for transcatheter aortic valve replacement: a prospective investigation.J Am Coll Cardiol. 2017; 69: 511-521
- How to perform transcaval access and closure for transcatheter aortic valve implantation.Cathet Cardiovasc Interv. 2015; 86: 1242-1254
- Transcaval access for TAVR across a polyester aortic graft.Cathet Cardiovasc Interv. 2015; 85: 1270-1273
Article info
Publication history
Published online: October 15, 2018
Accepted:
October 10,
2018
Received:
July 19,
2018
Footnotes
See page 1688.e19 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
