Modified Single-Puncture Technique for Transcatheter Aortic Valve Implantation in Patients without Peripheral Vascular Access

Abstract

Transcatheter aortic valve implantation (TAVI) is now routinely performed to treat inoperable and high-risk patients with severe aortic stenosis (AS). Transapical or transaortic approaches are alternative routes used when peripheral accesses are unsuitable.

Correct placement of the device is achieved with the help of an angiography performed with a pigtail catheter to identify the deployment view. However, in patients with severe vascular disease, placement of a pigtail catheter may not be possible.

We report a modified single-puncture technique, whereby a single access point is used to perform both angiography and TAVI by using visible calcification landmarks as reference points.

Keywords

aortic valve stenosis - transapical - transaortic - TAVI - vascular disease - difficult peripheral access - single-puncture technique

• References

• 1 Leon MB, Smith CR, Mack M , et al; PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363 (17) 1597-1607
• 2 Bapat VN, Attia RQ, Thomas M. Distribution of calcium in the ascending aorta in patients undergoing transcatheter aortic valve implantation and its relevance to the transaortic approach. JACC Cardiovasc Interv 2012; 5 (5) 470-476
• 3 Kasel AM, Cassese S, Leber AW, von Scheidt W, Kastrati A. Fluoroscopy-guided aortic root imaging for TAVR: “follow the right cusp” rule. JACC Cardiovasc Imaging 2013; 6 (2) 274-275
• 4 Prasad A, Compton PA, Prasad A , et al. Incidence and treatment of arterial access dissections occurring during cardiac catheterization. J Interv Cardiol 2008; 21 (1) 61-66
• 5 Piazza N, de Jaegere P, Schultz C, Becker AE, Serruys PW, Anderson RH. Anatomy of the aortic valvar complex and its implications for transcatheter implantation of the aortic valve. Circ Cardiovasc Interv 2008; 1 (1) 74-81