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Snare Technique to Facilitate ‘Tall-in-Short’ Redo-TAVR
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An 82-year-old man with a prior history of transcatheter aortic valve replacement (TAVR) with a 23-mm balloon-expandable transcatheter heart valve (THV) presented with bioprosthetic stenosis. Preoperative computed tomography revealed an underexpanded THV (Figure, A) with large sinuses with no risk for coronary obstruction (Figure, B). Hence, we decided to use a 26-mm self-expandable THV (Evolut FX 26 mm, Medtronic) to optimize hemodynamics for redo-TAVR.
The THV was crossed and a pre-shaped stiff wire (Confida, Medtronic) was inserted into the left ventricle apex. We were unable to advance the self-expandable prosthesis past the frame of the initial THV despite multiple attempts due to bias towards the greater curvature (Figure, C; Video 1). Next, we advanced a 25-mm Amplatz Goose Neck snare catheter (Medtronic) around the self-expandable THV and facilitated entry through the THV by pulling towards the lesser curvature. This snare technique centralized entry of the THV, and we were then able to perform successful redo-TAVR (Figure, E & F; Video 2)
To the best of our knowledge, this is the first reported use of a snare technique to facilitate ‘tall-in-short’ redo-TAVR. This snare technique should be considered in advance of the procedure, as it may be difficult to advance across the frame during redo-TAVR when using a tall THV platform without the ability to flex.
Affiliations and Disclosures
From the Department of Cardiology and Cardiothoracic Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA.
Disclosures: Dr Kaple is a speaker for Edwards Lifesciences and Abbott. The remaining authors report no financial relationships or conflicts of interest regarding the content herein.
Address for correspondence: Craig Basman, MD, FACC, FSCAI, Division of Cardiology, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, USA. Email: craigbasman@gmail.com; craig.basman@hmhn.org; X: @craigbasman
