Transcatheter Aortic Valve Implantation in the Hybrid Catheterisation Laboratory – Navigating into the Future

Abstract

Transcatheter aortic valve implantation (TAVI) has emerged as a viable treatment option for high-risk patients with symptomatic, senile degenerative aortic stenosis. Since the first TAVI in 2002, the technology has evolved tremendously. With the downsizing of the device delivery catheter profile, vascular access site complications have decreased significantly. Current access routes are transfemoral, subclavian, transapical and transaortic, with most centres preferring a ‘transfemoral-first’ strategy. Other significant complications of TAVI are cerebrovascular events and conduction disturbances with the need for pacemaker implantation. The current TAVI devices with the largest number of implantations and the best evidence are the Medtronic CoreValve™ and the Edwards SAPIEN XT™. Both devices are already in their third generation. Navigation technology, such as the HeartNavigator, has been developed to facilitate the preparation of the procedure and the actual device implantation. The use of hybrid catheterisation labs for performing TAVI is becoming the standard of care due to the significant advantages with regard to safety and hygiene.

Transcatheter valve‐in‐ring implantation of a repositionable valve system for treatment of severe mitral regurgitation

“…At our hospital, all valve procedures are performed in a designated class 1a hybrid cardiovascular operating room with laminar air flow (Philips/MAQUET) . All valve procedures are performed by the heart team under general anesthesia with endotracheal intubation, and invasive hemodynamic monitoring.…”

“…All valve procedures are performed by the heart team under general anesthesia with endotracheal intubation, and invasive hemodynamic monitoring. Procedures were guided by state of the art high‐definition fluoroscopy (Philips Healthcare) , and transesophageal echocardiography (TEE) (EPIQ7, Philips Healthcare). Patients were positioned supine, and the left ventricular (LV) apex accessed with a left lateral thoracotomy.…”