Transcatheter Balloon Expandable Aortic Valve Implantation through an Aortofemoral Bypass Graft

Abstract

An 84-year-old woman was diagnosed with symptomatic severe aortic stenosis. She had previously undergone aortobifemoral bypass grafting (Y graft) for bilateral iliac stenosis. In view of a high surgical risk, a decision for transcatheter aortic valve implantation (TAVI) was made. An incision was made on the right limb of the Y graft and subsequently a 16 Fr e-sheath was smoothly advanced through the graft. A 23 mm balloon expandable valve was then advanced with no resistance and successfully deployed. This case highlights the feasibility of TAVI through the graft, but requires a thorough preprocedural assessment of the access route using multiple imaging modalities.

Management of Transcatheter Aortic Valve Implantation and Complex Aorta Anatomy: The Importance of Pre-Procedural Planning

“…Obviously, this technique is useful only in the case of severe complex aorta anatomy, while the presence of a second stiff guide wire lying in the aorta without necessity can lead to some complications such as aortic dissection or perforation. Transfemoral TAVI with the "Buddy double-stiff guidewire" (as we have named it) technique can be feasible only if correctly used [16][17][18][19]. With this approach, we demonstrate that TAVI can be performed substantially safer and can reduce the likelihood of procedural complications even in high-risk patients with a very complex anatomy.…”

Transfemoral transcatheter aortic valve implantation using a self-expandable valve in a patient with an aortobiiliac bypass graft: a case report

“…As for the safety, efficacy, and long-term outcomes of the TF-TAVI in patients with artificial bypass grafts, there are no previous comparative studies though there are a few case reports (3). Therefore, further data should be accumulated in the future.…”

“…Considering peripheral artery disease is reportedly a major comorbidity in patients referred for TAVI (2), we may often face challenges in completing the TF-TAVI procedure in patients with comorbidities associated with femoral access routes such as the aorta or iliofemoral arteries with severe calcification, tortuosity, narrowing or an aneurysm, shaggy aorta, or an artificial bypass graft. Limited studies have highlighted the achievement of TF-TAVI using a Sapien XT balloon-expandable valve (Edwards Lifesciences, Irvine, CA, USA) in patients with aortobiiliac bypass grafts (3). To the best of our knowledge, we are the first to report a case of successful TF-TAVI using an Evolut R selfexpandable valve (Medtronic, Inc., Minneapolis, MN, USA) for symptomatic severe aortic stenosis in a patient with an aortobiiliac bypass graft.…”