Echo‐guided presentation of the aortic valve minimises contrast exposure in transcatheter valve recipients

Baranowski, J. M.; Ahn, Henrik Casimir; Freter, Wolfgang; Nielsen, Niels-Erik; Nylander, Eva; Janerot-Sjöberg, Birgitta; Sandborg, Michael; Wallby, Lars

doi:10.1002/ccd.22747

Cited by 9 publications

(7 citation statements)

References 5 publications

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“…Two percutaneous closure devices (Proglide™) were inserted prior to dilatation of the vessel. Adequate cusp alignment was facilitated with ultrasound-guided placement and adjustment of the image system [ 6 ]. TOE was used to confirm correct placement of the stent valve and to evaluate the hemodynamic result.…”

Section: Methodsmentioning

confidence: 99%

Can predilatation in transcatheter aortic valve implantation be omitted? - a prospective randomized study

Ahn

Nielsen

Baranowski

2016

J Cardiothorac Surg

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BackgroundThe use of a balloon expandable stent valve includes balloon predilatation of the aortic stenosis before valve deployment. The aim of the study was to see whether or not balloon predilatation is necessary in transcatheter aortic valve replacement (TAVI).MethodsSixty consecutive TAVI patients were randomized to the standard procedure or to a protocol where balloon predilatation was omitted.ResultsThere were no significant differences between the groups regarding early hemodynamic results or complication rates.ConclusionsTAVI can be performed safely without balloon predilatation and with the same early results as achieved with the standard procedure including balloon predilatation. The reduction in the number of pacing periods required may be beneficial for the patient.

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Section: Methodsmentioning

confidence: 99%

Can predilatation in transcatheter aortic valve implantation be omitted? - a prospective randomized study

Ahn

Nielsen

Baranowski

2016

J Cardiothorac Surg

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“…In a study on over 7500 patients who underwent percutaneous coronary intervention Rihal et al [8] found that acute renal failure correlated with the volume of contrast medium administered [8]. Echo guidance of fluoroscopic equipment has meant that we can reduce and in many cases avoid contrast delivery to verify good alignment of the aortic cusps [11]. In our series of 229 patients using this method 1/3 did not receive any contrast and 90% received 50 ml or less.…”

Section: Discussionmentioning

confidence: 68%

“…Step 1: An Echo-guided method for aortic cusp alignment From early on we began using transesophageal echocardiography to guide the fluoroscopy instrument setting for good alignment of the aortic cusps [11]. Once an optimal echocardiographic view was obtained, the image intensifier was adjusted to the transducer's direction.…”

Section: Methodsmentioning

confidence: 99%

A Simplified Protocol for Transcatheter Aortic Valve Implantation that Reduces Procedure-Related Risk

Baranowski¹,

Nielsen

Ahn

2016

J Cardiovasc Dis Diagn

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Objectives: Transcatheter Aortic Valve Implantation is now a well-established procedure and continuous development has improved the technique. The object of this paper is to describe the successive steps taken at our department to improve our protocol, resulting in a more effective and patient-safe procedure.Design: An echo-guided method for aortic cusp alignment was used in 229 patients. In 139 patients predilatation was excluded from the protocol. In the last 47 of the patients we exchanged the stiff guide-wire in the left ventricle with a soft wire for valve placement.Results: There was a significant decrease in the use of contrast medium during the period with 90% of patients receiving less than 50 ml contrast and 35% no contrast at all. In more than half the patients we only used rapid pacing in association with deployment of the stent valve. We had six cases of pericardial bleeding due to penetration of the stiff guide wire through the left ventricular (LV) wall. This complication was avoided in all subsequent patients where we exchanged the stiff catheter to a soft guidewire in the ascending aorta before introduction of the wire and stent valve into the LV. Conclusions:We have successively modified our standard protocol for implantation of a balloon-expandable transcatheter aortic valve. This has simplified the procedure and reduced the risk for certain procedure-related complications.

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“…Moreover, even if it appears with low incidence, immediate hypersensitivity reaction to MRI contrast media (0.1%) is possible [7]. During transcatheter aortic valve implantation (TAVI), echocardiography guiding is an efficient tool to reduce the use of ICM as shown by several studies [8,9]. It allows a fine positioning of the device before deployment and a precise post-implantation control: occurrence of a complication, assessment of bioprosthesis function, estimation of paraprosthesis leak [10], and in favorable situations, assessment of coronary flow [11].…”

Section: Discussionmentioning

confidence: 99%

Successful transfemoral aortic Edwards^®SAPIEN^® bioprosthesis implantation without using iodinated contrast media in a woman with severe allergy to contrast agent

Leroux

Dijos

Santos

2013

Cathet Cardio Intervent

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Severe anaphylactoid reaction after the use of iodinated contrast media are rare but can contraindicate the use of contrast agent. It was the case of a 53-year-old woman suffering from symptomatic severe aortic stenosis, recused for cardiac surgery because of deleterious effects of chest-wall irradiation, with porcelain aorta. We decided to implant a 23-mm Edwards(®) SAPIEN(®) transcatheter aortic valve via a femoral route without using any contrast media. The implantation was successful after surgical approach of the femoral artery, transesophageal echocardiography guiding, and localization of native leaflets and coronary trunk with catheters. Immediate and one month post-interventional follow-up was favorable and echocardiography showed a good functioning of the aortic bioprosthesis. Although conventional angiography is the best way to visualize the good positioning of the valve before deployment, our case suggests that, in special situations, transfemoral implantation of an Edwards(®) SAPIEN(®) aortic bioprosthesis is feasible without any contrast injection.

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Echo‐guided presentation of the aortic valve minimises contrast exposure in transcatheter valve recipients

Cited by 9 publications

References 5 publications

Can predilatation in transcatheter aortic valve implantation be omitted? - a prospective randomized study

Can predilatation in transcatheter aortic valve implantation be omitted? - a prospective randomized study

A Simplified Protocol for Transcatheter Aortic Valve Implantation that Reduces Procedure-Related Risk

Successful transfemoral aortic Edwards^®SAPIEN^® bioprosthesis implantation without using iodinated contrast media in a woman with severe allergy to contrast agent

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Echo‐guided presentation of the aortic valve minimises contrast exposure in transcatheter valve recipients

Cited by 9 publications

References 5 publications

Can predilatation in transcatheter aortic valve implantation be omitted? - a prospective randomized study

Can predilatation in transcatheter aortic valve implantation be omitted? - a prospective randomized study

A Simplified Protocol for Transcatheter Aortic Valve Implantation that Reduces Procedure-Related Risk

Successful transfemoral aortic Edwards®SAPIEN® bioprosthesis implantation without using iodinated contrast media in a woman with severe allergy to contrast agent

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Successful transfemoral aortic Edwards^®SAPIEN^® bioprosthesis implantation without using iodinated contrast media in a woman with severe allergy to contrast agent