A Completely Endovascular Solution for Transcatheter Aortic Valve Implantation Embolisation and Inversion into the Aortic Arch
| Autor: | Theo P. Menting, Martin G. Stoel, Robert H. Geelkerken, Steven J.G. Leeuwerke |
|---|---|
| Přispěvatelé: | Multi-Modality Medical Imaging, TechMed Centre |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Aortic arch
Aorta medicine.medical_specialty Transcatheter aortic Endovascular business.industry medicine.medical_treatment Short Report Embolisation Balloon medicine.disease Surgery TAVI Aortic (valve) stenosis Valve replacement Thoracic stent graft medicine.artery Aortic valve stenosis Descending aorta medicine cardiovascular system Cardiology and Cardiovascular Medicine Complication business |
| Zdroj: | EJVES Vascular Forum EJVES Vascular Forum, 52, 13-16. Elsevier |
| ISSN: | 2666-688X |
| Popis: | Introduction Transcatheter aortic valve implantation (TAVI) has evolved into the preferred alternative to surgical valve replacement for severe aortic valve stenosis with high surgical risk. With expanding indications, life threatening complications including transcatheter aortic valve embolisation and inversion (TAVEI), in which the valve dislodges, inverts, and migrates caudally, may increase concomitantly. Report An 80 year old male with severe aortic valve stenosis underwent balloon expandable transcatheter aortic valve implantation (TAVI). Valve embolisation into the aortic arch inverted the bioprothesis, excluding the option of fixation in the descending aorta. Through-valve thoracic endovascular aortic repair (TEVAR) was performed after bifemoral snaring using a through-and-through wire technique and pulling the valve into the descending aorta. Discussion TAVI is emerging as the preferred treatment for severe aortic valve stenosis and comes with unique procedural complications, such as life threatening transcatheter aortic valve embolisation and inversion (TAVEI). Although some authors prefer treating embolisation of a non-inverted balloon expandable valve into the aorta by using the valvuloplasty balloon to pull the valve distally and fixing it in the descending aorta, this risks further expansion of the valve and consequently fixing it in an undesirable position and is not possible if the valve inverts. Downstream placement of the valve by snaring with a guiding catheter covering/protecting a through-and-through wire technique, combined with through-valve TEVAR, provides a new bail out strategy for this serious complication and may reduce TAVEI associated mortality and morbidity. Highlights • TAVI is preferred to open replacement when treating severe aortic valve stenosis. • An embolized valve may invert (TAVEI) risking hemodynamical obstruction. • Snaring with a through-and-through wire allows downstream valve placement. • A covered through-and-through wire protects the aortic wall during snaring. • Thoracic stent-grafting provides a completely endovascular solution for TAVEI. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|