799 Case Study: Ultra Low Contrast Diagnostic and Zero Contrast Percutaneous Coronary Intervention

Abstract

Background: Symptomatic severe aortic stenosis (AS) is common in the elderly with a prevalence of 10% in the age group.than 80. Aortic valve replacement (AVR) is the recommended treatment for patients with symptomatic severe AS. In certain cases, bridging to AVR with a balloon aortic valvuloplasty (BAV) may be needed to stablise the patient. We present a trans-radial BAV case. Case: A frail 76 year-old female with severe AS (mean gradient 70mmHg) admitted with congestive cardiac failure was being considered for trans-catheter aortic valve implantation (TAVI). Due to complex access, anatomical issues and frailty, she was planned for a BAV to assess her symptomatic improvement prior to undertaking an alternate access TAVI. A trans-femoral route was initially attempted. Under conscious sedation, a 5-French sheath was inserted into the right common femoral artery (left common femoral was occluded) under ultrasound guidance with the use of a micro-puncture needle. A slippery wire and a BMW wire were unsuccessful in crossing a severely stenosed external iliac artery. With repeated attempts a retrograde dissection resulted, and this strategy was abandoned. A 6-French radial sheath was inserted and upgraded to a 7-French. The aortic valve was crossed with an AL 0.75 and a straight wire. BAV was undertaken with a 16 mm TYSHAK II (7French compatible). Trans-aortic Peak to Peak gradient went from 80mmHg to 50mmHG. Haemostasis achieved with a TR Band and manual pressure. Conclusion: To our knowledge, this is the first case of a successful BAV via the radial approach.