Description of the Step-by-Step Technique With Snare Catheter for TAVR in Horizontal Aorta

Rueda, Manuel A. Espinoza; González, Roberto Muratalla; García, Juan.F. García; Portano, Julieta Danira Morales; Meléndez, Marco Antonio Alcántara; Valverde, Arnoldo S. Jiménez; Gálvez, Ronald E. Rivas; Delgadillo, Jorge L. Campos; González, César L.; Ortiz, José R. Gayosso; Rajmé, José Alfredo Merino

doi:10.1016/j.jaccas.2021.09.006

Cited by 8 publications

(5 citation statements)

References 4 publications

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“…According to the reported cases of snare-assisted SE-TAVR, the snare was usually introduced via the radial artery or contralateral femoral artery [11][12][13][14][15][16]. In our experience, however, the ipsilateral snare was the default technique, and in over 50% of the cases, the snare was introduced along with the delivery system via the same large sheath.…”

Section: Discussionmentioning

confidence: 91%

“…A few case reports have described the application of snare to overcome the difficulties in advancing the delivery system of SE valves [11][12][13][14][15]. However, there have been very limited data regarding the usefulness and safety of the maneuver.…”

Section: Discussionmentioning

confidence: 99%

“…Typically, the prosthesis is captured with a contralateral or ipsilateral 2 of 11 snare catheter, on which an external traction force is applied to pull the delivery system toward the inner curvature to facilitate its advancement through the ascending aorta and aortic valve. However, reported experiences with the approach are limited to case reports or case series [11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies

Yao

Zhang

Wang

et al. 2023

JCM

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The snare-assisted technique has been described to facilitate transcatheter aortic valve replacement (TAVR) delivery system advancement in complex aortic anatomies. However, the evidence is limited to case reports. To evaluate the safety profile of the snare-facilitated approach and its impact on self-expanding (SE) TAVR outcomes, we collected consecutive patients who underwent transfemoral SE-TAVR for aortic stenosis, using propensity score matching (PSM) separately in tricuspid and type-0 and type-1 bicuspid aortic valve morphology between the snare and non-snare groups. In 766 patients, despite the snare group having significantly larger annulus angulation and maximal ascending aortic diameter, both groups achieved comparable 30-day device success rates, regardless of first-generation or new-generation valve use. After PSM, the snare group had a significantly lower new permanent pacemaker implantation rate among 193 type-0 patients (3.3% vs. 18.3%, p = 0.01). The ipsilateral group used new-generation valves less frequently (23.0% vs. 75.4%, p < 0.001), but there were no significant inter-group differences in procedure-related events, except for a lower incidence of PVL ≥ mild in the ipsilateral group (14.9% vs. 32.3%, p = 0.01). In conclusion, the snare-assisted technique appears useful in SE-TAVR with angulated aortic root anatomy, and the benefits were comparable between ipsilateral and contralateral snare techniques.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies

Yao

Zhang

Wang

et al. 2023

JCM

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“…This technique, despite being recognized to manage several complications after TAVI, 10 is mainly used to valve repositioning after low implantation, in cases of severe paravalvular regurgitation, or to facilitate valve implantation in challenging anatomies. 13 , 14 Its use for valve retrieval after coronary occlusion is seldomly reported in medical literature, and to best of our knowledge, this is one the first case reports describing it to resolve a life-threatening coronary occlusion after TAVI.…”

Section: Discussionmentioning

confidence: 92%

Acute left main coronary occlusion after transcatheter aortic valve implantation: life-saving intervention using the snare technique—a case report

Lopes

Brito

Teles

et al. 2022

European Heart Journal - Case Reports

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Background Transcatheter aortic valve implantation (TAVI) has rapidly evolved and changed the field of structural cardiovascular intervention. Its advances lead to a marked reduction in the risk of complications and improved outcomes. However, TAVI is still associated with potential serious complications. Case summary A 73-year-old man with severe aortic stenosis underwent TAVI using a 34-mm self-expanding aortic bioprosthesis. After valve deployment, the patient rapidly progressed to cardiac arrest. Acute left main occlusion, due to high valve implantation, was promptly recognized and advanced life support immediately initiated. Concomitantly, the valve was successfully retrieved toward the ascending aorta using the snare technique, resulting in immediate restoration of flow and successful cardiopulmonary resuscitation. Subsequently, a 29-mm balloon-expandable aortic bioprosthesis was uneventfully implanted. After TAVI, the patient had a remarkable clinical evolution and was discharged home at hospitalization day 5 without relevant electrocardiographic nor echocardiographic disturbances. At 6-month follow-up, the patient remains asymptomatic and transthoracic echocardiography revealed a normofunctional aortic bioprosthesis with preserved left ventricular ejection fraction. Discussion Acute coronary occlusion is a rare and life-threating complication of TAVI that may be prevented with accurate procedure planning. Pre-procedural computed tomography angiography is essential for a comprehensive patient evaluation, allowing appropriate valve selection, a key factor for successful management. Self-expandable valve retrieval with snare technique can be an appropriate strategy for the management of this complication. This case highlights the importance of performing these procedures in highly experienced centers and with fully equipped catheterization laboratories to allow timely interventions when facing unexpected events.

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“…Previously, case reports and case series have described snare-assisted TAVR as a solution for patients with severely tortuous or calcified aortas to avoid vascular complications ( 5 ). It has also served as a bail-out technique to facilitate THV passage through the aortic valve in cases with horizontal aortas or severely stenotic aortic valves.…”

Section: Introductionmentioning

confidence: 99%

Case Report of snare-assisted coaxiality optimized technique during valve deployment in patient with pure aortic regurgitation

Yu,

Du,

Ding

et al. 2024

Front. Cardiovasc. Med.

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In high-risk patients with pure native aortic regurgitation (PNAR), transcatheter aortic valve replacement (TAVR) remains an off-label intervention. Due to anatomical variations in the aortic root and technical challenges unique to PNAR, the transfemoral approach (TF-TAVR) requires continued accumulation of experience and technological refinement. In this context, we successfully and safely performed a snare-assisted TF-TAVR procedure for a patient with PNAR, characterized by significant aortic angulation. We introduced an innovative technique termed “snare-assisted coaxiality optimized technique” (SACOT) during valve deployment. SACOT played a crucial role in optimizing valve positioning, enhancing coaxiality, and achieving the ideal implantation depth for PNAR. Post-procedure assessments demonstrated stability and the absence of paravalvular regurgitation (PVR).

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Description of the Step-by-Step Technique With Snare Catheter for TAVR in Horizontal Aorta

Cited by 8 publications

References 4 publications

Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies

Snaring Self-Expanding Devices to Facilitate Transcatheter Aortic Valve Replacement in Patients with Complex Aortic Anatomies

Acute left main coronary occlusion after transcatheter aortic valve implantation: life-saving intervention using the snare technique—a case report

Case Report of snare-assisted coaxiality optimized technique during valve deployment in patient with pure aortic regurgitation

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