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Single-Access Parallel Wire Technique for Transcatheter Aortic Valve Implantation
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J INVASIVE CARDIOL 2024. doi:10.25270/jic/24.00179. Epub June 12, 2024.
Single access transfemoral transcatheter aortic valve implantation (TAVI) is considered to be a safe practice. Nonetheless, this strategy relies on the calcification of anatomical landmarks to position the transcatheter heart valve (THV). Herein, we describe the use of parallel wires to aid the implantation of a THV in a patient who lacked significant aortic valve calcification.
A 91-year-old man with a background of hypertension and abdominal aortic aneurysm was transferred for TAVI following admission with congestive heart failure. His echocardiogram established severe aortic stenosis and computed tomography confirmed feasibility of the transfemoral approach.
The procedure was planned as a single access TAVI using the right trans-femoral approach. A 16-French (Fr) eSheath (Edwards Lifesciences) was inserted and a 6-Fr pigtail was positioned in the noncoronary cusp (Figure A). The pigtail was exchanged over a standard 0.35-inch wire, which was left in the non-coronary cusp given the lack of calcification landmarks. A pre-shaped stiff wire was placed in the left ventricle in a standard fashion (Figure B).
A 29-mm Sapien Ultra THV (Edwards Lifesciences) was advanced into the eSheath with the parallel wire in place (Figure C, D). The THV was positioned at the annulus using the deflected portion of the 0.35-inch wire as a visual aid to match the bottom border of the balloon marker within the THV (Figure E). The THV was deployed under rapid pacing via the left ventricle wire and the position of the valve was confirmed using contrast under fluoroscopy (Figure F). The procedure was completed in a standard fashion without vascular complication or conduction disturbance. The patient made good clinical recovery and was discharged 2 days after the TAVI procedure.
This case demonstrated the feasibility of performing a TAVI procedure using a single-access transfemoral approach, even in the absence of calcified anatomical landmarks.
Affiliations and Disclosures
From the 1Cardiothoracic Centre, Freeman Hospital, Newcastle-upon-Tyne, UK; 2Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK.
Disclosures: The authors report no financial relationships or conflicts of interest regarding the content herein.
Consent statement: Informed consent was obtained from the patient for the intervention and the publication of the data.
Address for correspondence: Mohammad Alkhalil, MD, Department of Cardiothoracic Services, Freeman Hospital, Freeman Road, Newcastle-upon-Tyne NE7 7DN, UK. Email: mohammad.alkhalil@nhs.net
