Preventing brain embolism by using a modified isolation technique in transcatheter aortic valve implantation for a patient with shaggy and porcelain aorta

Abstract

Transcatheter aortic valve implantation (TAVI) is less invasive compared to surgical aortic valve replacement and is indicated for patients with symptomatic aortic valve stenosis (AS) at high operative risk. The incidence of cerebral embolism following the procedure is reported to be over 70% as evaluated by diffusion-weighted magnetic response imaging, which includes silent stroke [1]. The large Transcatheter Valve Therapies registry showed that the composite outcome of mortality and stroke occurs in 26.0% of patients over 1 year of follow-up [2]. Various devices that are designed to prevent emboli into the cerebral arteries need to be inserted before navigating through the aortic arch. However, inserting such protective devices into a diseased aorta is regarded as a risk factor for stroke.Here, we report a case of TAVI in a patient with an extremely shaggy and porcelain aorta and congestive heart failure using a modified isolation technique with cardiopulmonary bypass (CPB). The patient consented to the publication of this report. Case reportAn 89-year-old man was seen by a family physician for complaints of nocturnal dyspnea. He had a history of brain

The Shaggy Aorta Syndrome: An Updated Review

“…Stroke and paraplegia 55 are potential complications associated with TAVI, and SA increases the risk for cerebral complication. In this context, Nomura et al 56 and Sawazaki et al 36 adopted a modified artery isolation technique without using conventional protection devices through bilateral axillary artery perfusion resulting effective for the prevention of cerebral embolism.…”

Cerebral Protection Using Percutaneous Normothermic Bilateral Antegrade Cerebral Perfusion During Total Arch TEVAR in a Patient With Shaggy Aorta

“…The technique protected only the anterior cerebral circulation and required multiple cutdowns. Nomura and colleagues 13 used bilateral axillary artery perfusion to achieve LCCA flow reversal during transcatheter aortic valve replacement in a patient with shaggy aorta, but this technique is dependent on a complete circle of Willis to be fully effective.…”