Combined Retrograde/Antegrade Approach to Transcatheter Closure of an Aortic Paravalvular Leak

Damluji, Abdulla A.; Kaynak, Husnu E.; Heldman, Alan W.

doi:10.14503/thij-14-4239

Cited by 4 publications

(4 citation statements)

References 9 publications

(9 reference statements)

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“…The so-called "Tootsie Roll Technique" of sequential deployment of a covered stent and vascular plug, which may Fluoro-angiographic intra-procedural procedural steps (1). Left anterior oblique (A) and right anterior oblique (B) aortography with a Pig-tail 5-Fr catheter showing severe regurgitation (white arrows) through a highly calcified paravalvular leak of a self-expandable transcatheter aortic valve (TAVI) (26 mm Evolut TM R ® ); white asterisks indicate the large calcific nodules in the annular region.…”

Section: Discussionmentioning

confidence: 99%

“…PVL closure after SE TAVI may be more challenging than after balloon-expandable valve implantation, as strut avoidance is much more difficult ( 1 , 2 ). A high burden of calcium may persist in the TAVI device landing zone, limiting equipment accessibility and navigation between the prosthesis frame and native tissue ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, IVL application greatly facilitates the progression of the delivery sheath and occluder which is key to a successful procedure. KEYWORDS paravalvular leak regurgitation, calcified paravalvular leak, self-expandable transcatheter aortic valve implantation, paravalvular leak closure, intravascular lithotripsy Introduction PVL closure after SE TAVI may be more challenging than after balloon-expandable valve implantation, as strut avoidance is much more difficult (1,2). A high burden of calcium may persist in the TAVI device landing zone, limiting equipment accessibility and navigation between the prosthesis frame and native tissue (3).…”

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confidence: 99%

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Intravascular lithotripsy (IVL) enabled the percutaneous closure of a severely calcified paravalvular leak regurgitation following implantation of a self-expandable transcatheter aortic valve: a case report

Evola,

D’Agostino,

Adorno

et al. 2024

Front. Cardiovasc. Med.

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BackgroundClosure of paravalvular leak (PVL) regurgitation after self-expandable (SE) transcatheter aortic valve implantation (TAVI) may be more challenging than after balloon-expandable (BE) valve implantation.Case summaryAn 85-year-old woman suffering from long-standing atrial fibrillation and severe symptomatic aortic stenosis underwent SE TAVI (26 mm Evolut™ R®, Medtronic Inc., MN, USA). A total of eighteen months after TAVI she was admitted for congestive heart failure and two-dimensional (2D) transesophageal echocardiography (TEE) color Doppler showed moderate-severe PVL regurgitation due to a long and heavily calcified leak located below the left coronary sinus. The patient was deemed to be at prohibitive surgical risk and a catheter-based PVL closure procedure was planned. A first attempt to cross the PVL from the femoral artery was unsuccessful due to an inappropriate angle between the catheter and the entry site of this hard-to-approach calcified leak. A Terumo hydrophilic guidewire 0.35 inch-260 cm from the right radial artery was then successfully advanced across the leak to the left ventricle (LV); however, of most of the catheters used, only a Glidecath 4-Fr could cross the leak over the hydrophilic wire. The hydrophilic guidewire was replaced with a stiffer guidewire that, after creating a loop in the LV, was advanced across the self-expandable valve into the descending aorta where it was snared and externalized through the left femoral artery, thus creating an arterio-arterial (AA) loop. A 6-Fr Multipurpose guiding catheter was advanced over the exchange wire and the leak was crossed with an additional 0.0014 coronary guidewire (PILOT, Abbott Vascular), predilated with two non-compliant balloon dilatation catheters, and finally, the PVL was engaged with a 3.0 mm × 12 mm Shockwave balloon (Shockwave Medical Inc, Santa Clara, California, USA). Intravascular lithotripsy (IVL) application to this highly calcified leak and the increased support provided by the stiff guidewire finally allowed the progression of the 6-Fr dedicated delivery sheath (ODS III) into the LV. A 5 mm square twist (ST) device (PLD, Occlutech, Helsingborg, Sweden) was successfully deployed within the leak and the final echocardiographic and angiographic control confirmed the effective PVL closure.DiscussionIn patients at high surgical risk with moderate to severe regurgitation after SE TAVI due to a hard-to-approach calcified long tract, an extra AA support loop is mandatory during percutaneous PVL closure. Furthermore, IVL application greatly facilitates the progression of the delivery sheath and occluder which is key to a successful procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Intravascular lithotripsy (IVL) enabled the percutaneous closure of a severely calcified paravalvular leak regurgitation following implantation of a self-expandable transcatheter aortic valve: a case report

Evola,

D’Agostino,

Adorno

et al. 2024

Front. Cardiovasc. Med.

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“…In patients with an aortic paravalvular leak (PVL), the retrograde femoral arterial approach is most commonly used [ 1 , 2 ]. Nevertheless, in some cases an antegrade (via trans-septal puncture) or a retrograde transapical approach may be alternative options [ 3 ]. Particularly for the anatomically hard-to-approach calcified serpiginous tracts where an extra support is needed, an arterio-arterial loop can be established and may be key for a successful procedure [ 4 ].…”

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confidence: 99%