Percutaneous paravalvular leak closure after CoreValve transcatheter aortic valve implantation using an arterio-arterial loop

Estévez‐Loureiro, Rodrigo; Benito‐González, Tomas; Gualis, Javier; Prado, Armando Pérez de; Cuellas, Carlos; Fernández‐Vázquez, Felipe

doi:10.21037/jtd.2017.02.41

Cited by 6 publications

(4 citation statements)

References 6 publications

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“…In the majority of cases, SE valves require wire and catheter advancement through the valve struts and their manipulation can be challenging. Generally, it is difficult to advance delivery catheters, so the creation of an AA loop through the leak can be very helpful to cross through the SE struts and overcome the inner leak resistance ( 4 , 5 ). In the majority of patients, the use of an additional coronary wire (buddy wire) can help advance non-compliant balloon dilatation catheters with the aim of enlarging the hard-to-approach leakage.…”

Section: Discussionmentioning

confidence: 99%

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Intravascular lithotripsy (IVL) enabled the percutaneous closure of a severely calcified paravalvular leak regurgitation following implantation of a self-expandable transcatheter aortic valve: a case report

Evola,

D’Agostino,

Adorno

et al. 2024

Front. Cardiovasc. Med.

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BackgroundClosure of paravalvular leak (PVL) regurgitation after self-expandable (SE) transcatheter aortic valve implantation (TAVI) may be more challenging than after balloon-expandable (BE) valve implantation.Case summaryAn 85-year-old woman suffering from long-standing atrial fibrillation and severe symptomatic aortic stenosis underwent SE TAVI (26 mm Evolut™ R®, Medtronic Inc., MN, USA). A total of eighteen months after TAVI she was admitted for congestive heart failure and two-dimensional (2D) transesophageal echocardiography (TEE) color Doppler showed moderate-severe PVL regurgitation due to a long and heavily calcified leak located below the left coronary sinus. The patient was deemed to be at prohibitive surgical risk and a catheter-based PVL closure procedure was planned. A first attempt to cross the PVL from the femoral artery was unsuccessful due to an inappropriate angle between the catheter and the entry site of this hard-to-approach calcified leak. A Terumo hydrophilic guidewire 0.35 inch-260 cm from the right radial artery was then successfully advanced across the leak to the left ventricle (LV); however, of most of the catheters used, only a Glidecath 4-Fr could cross the leak over the hydrophilic wire. The hydrophilic guidewire was replaced with a stiffer guidewire that, after creating a loop in the LV, was advanced across the self-expandable valve into the descending aorta where it was snared and externalized through the left femoral artery, thus creating an arterio-arterial (AA) loop. A 6-Fr Multipurpose guiding catheter was advanced over the exchange wire and the leak was crossed with an additional 0.0014 coronary guidewire (PILOT, Abbott Vascular), predilated with two non-compliant balloon dilatation catheters, and finally, the PVL was engaged with a 3.0 mm × 12 mm Shockwave balloon (Shockwave Medical Inc, Santa Clara, California, USA). Intravascular lithotripsy (IVL) application to this highly calcified leak and the increased support provided by the stiff guidewire finally allowed the progression of the 6-Fr dedicated delivery sheath (ODS III) into the LV. A 5 mm square twist (ST) device (PLD, Occlutech, Helsingborg, Sweden) was successfully deployed within the leak and the final echocardiographic and angiographic control confirmed the effective PVL closure.DiscussionIn patients at high surgical risk with moderate to severe regurgitation after SE TAVI due to a hard-to-approach calcified long tract, an extra AA support loop is mandatory during percutaneous PVL closure. Furthermore, IVL application greatly facilitates the progression of the delivery sheath and occluder which is key to a successful procedure.

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Section: Discussionmentioning

confidence: 99%

“…A high burden of calcium may persist in the TAVI device landing zone, limiting equipment accessibility and navigation between the prosthesis frame and native tissue (3). For anatomically hard-to-approach long calcified tracts, the use of a radial approach and the creation of an extra AA support loop can greatly facilitate the closure procedure (4)(5)(6).…”

mentioning

confidence: 99%

Intravascular lithotripsy (IVL) enabled the percutaneous closure of a severely calcified paravalvular leak regurgitation following implantation of a self-expandable transcatheter aortic valve: a case report

Evola,

D’Agostino,

Adorno

et al. 2024

Front. Cardiovasc. Med.

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“…Mother and child catheter techniques or AV loops are of paramount importance in this setting as delivery catheters are generally difficult to advance. The creation of arterio-arterial or arterio-venous loops through the leak and antegrade progression of delivery catheters from the LV across the PVL may be very helpful to overcome the resistance in order to cross through the struts of the valve from a retrograde approach ( Figure 3 ) [ 21 ].…”

Section: Pvl Regurgitation After Tavi: Procedural Aspectsmentioning

confidence: 99%

Paravalvular Leakages after Surgical Aortic-Valve Replacement and after Transcatheter Aortic-Valve Implantation: Strategies to Increase the Success Rate of Percutaneous Closure

Freixa

Gabani

Cepas‐Guillén

et al. 2022

JCM

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Moderate to severe paravalvular-leak (PVL) regurgitation after surgical aortic-valve replacement or after transcatheter valve implantation represents a well-known complication associated with symptoms related to heart failure, hemolysis, or both in patients with multiple comorbidities and with poor prognostic outcomes. The transcatheter closure of aortic paravalvular leaks (APVLs) is currently considered a valid alternative to cardiac surgery. Nevertheless, careful patient selection, optimal cardiac imaging for intraprocedural guidance, and expert operators are key for success. Although technically demanding, particularly in APVLs after transcatheter valve implantation, catheter-based closure is an effective, less invasive, and often the only option for high-risk patients with symptomatic PVL regurgitation.

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“…However, in large and high volume leaks, for implanting the appropriate device, large sheaths may be needed. Particularly in self-expanding prostheses, valve struts and calcification of the annulus may complicate the advancement of delivery systems mainly when using large sheaths [23] .…”

Section: Central Leakmentioning

confidence: 99%

Complications of transcatheter aortic valve replacement and rescue attempts

Depboylu¹,

Yazman²,

Harmandar³

2018

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How to cite this article: Depboylu BC, Yazman S, Harmandar B. Complications of transcatheter aortic valve replacement and rescue attempts. Vessel Plus 2018;2:26. http://dx. AbstractAs a novel treatment modality, transcatheter aortic valve replacement (TAVR) is widely used for patients with severe aortic valve stenosis who have high surgical risk worldwide. However, this promising alternative procedure has different types of complication risks including, cerebrovascular events, vascular complications, bleeding, coronary obstruction, myocardial infarction, valve regurgitation, valve malpositioning or migration, conduction disturbances and acute kidney injury which may occur during and/or after the procedure. These complications may be seen up to one third of the patients and some of them may need urgent surgical intervention and may have a higher risk of death. For preventing and overcoming these complications, pre-procedural evaluation of the patient by an effective "heart team" which consists of cardiologists, cardiac surgeons, radiologists and anesthesiologists in equal proportion is needed. Estimating the potential difficulties and complications, deciding the interventions to be performed in case of any complication may increase the success of the procedure and save the patients' lives. In this article, we reviewed the possible complications of the TAVR procedure and described rescue procedures in case of complications, in the context of the literature.

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Percutaneous paravalvular leak closure after CoreValve transcatheter aortic valve implantation using an arterio-arterial loop

Cited by 6 publications

References 6 publications

Intravascular lithotripsy (IVL) enabled the percutaneous closure of a severely calcified paravalvular leak regurgitation following implantation of a self-expandable transcatheter aortic valve: a case report

Intravascular lithotripsy (IVL) enabled the percutaneous closure of a severely calcified paravalvular leak regurgitation following implantation of a self-expandable transcatheter aortic valve: a case report

Paravalvular Leakages after Surgical Aortic-Valve Replacement and after Transcatheter Aortic-Valve Implantation: Strategies to Increase the Success Rate of Percutaneous Closure

Complications of transcatheter aortic valve replacement and rescue attempts

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