Unexpected Complications of Transapical Aortic Valve Implantation

Al‐Attar, Nawwar; Ghodbane, Walid; Himbert, Dominique; Rau, Céderic; Raffoul, Richard; Messika–Zeitoun, David; Brochet, Éric; Vahanian, Alec; Nataf, Patrick

doi:10.1016/j.athoracsur.2009.03.070

Cited by 111 publications

(60 citation statements)

References 16 publications

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“…Alternatively, a transapical approach (TA-TAVI) can be employed [6]. Still, this route has certain limitations; it is not recommended in patients with chronic lung diseases or poor left ventricular function, and is associated with a risk of serious bleeding complications [7][8][9]. The use of transaortic (TAo) access is a more recently developed alternative to TA-TAVI and TF-TAVI [10,11].…”

Section: Introductionmentioning

confidence: 99%

Transaortic transcatheter aortic valve implantation: Results of the Polish arm of the ROUTE registry

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Transaortic transcatheter aortic valve implantation: Results of the Polish arm of the ROUTE registry

et al. 2015

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“…1,2 To the best of our knowledge, our case illustrates an intriguing late complication that highlights the importance of clinical awareness and multimodality cardiac imaging.…”

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confidence: 99%

Aortic Root Pseudoaneurysm 1 Year After Transapical Aortic Valve Implantation

et al. 2010

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A n 84-year-old woman was admitted to our institution for transapical aortic valve implantation (TAVI) because of severe aortic stenosis coexisting with high-risk clinical conditions. She had a past history of type 2 diabetes mellitus, hypertension, intrinsic asthma, moderate to severe chronic renal insufficiency (Modification of Diet in Renal Disease glomerular filtration rate, 36 mL/min per 1.73 m 2 ), and peripheral atherosclerotic vascular disease involving both iliofemoral arteries. Eighteen months before, she had suffered a non-ST-segment elevation myocardial infarction and was treated with 2 bare metal stents on the middle segment of the left anterior descending coronary artery and the very proximal or ostial segment of the right coronary artery. Aortic stenosis was evaluated as moderate. After 5 months, she developed advanced Mobitz II-type atrioventricular block, and a permanent sequential atrial synchronous ventricular inhibited pacemarker was indicated. Progression of the aortic valve disease was not noted. More recently, she was admitted to another hospital with severe dyspnea, showing signs of acute heart failure on physical examination. Urgent transthoracic echocardiogram disclosed a normal left ventricle with preserved ejection fraction and progression of the severity of the aortic valve stenosis. Because of the very high operative risk, conventional on-pump aortic valve replacement was dismissed.Before TAVI, a complete transesophageal echocardiographic (TEE) study confirmed the presumptive diagnosis of severe aortic stenosis (Figure 1). The findings were those expected for degenerative valvulopathy (severe thickness and calcification of the leaflets and critical reduction of the valve opening), showing normal characteristics of the aortic root. Precise measurement of the aortic annulus was accomplished with TEE to determine the appropriate prosthetic size. A successful procedure with a 23-mm SAAPIEN bovine pericardial valve (Edwards Lifesciences Inc, Irvine, Calif) was performed. Intraoperative TEE and fluoroscopy confirmed only minimal aortic regurgitation. The patient was discharged on the 10th postoperative day in very good condition, with normal function of the bioprosthesis on echocardiography. At 3-and 6-month follow-ups, the patient was in functional class II, and the echocardiograms revealed good function of the valve, with minimal aortic regurgitation observed during both checkups.One year later, the patient presented with angina with atypical characteristics. She was referred again to the echocardiography laboratory to assess prosthetic function and coronary stent patency with pharmacological stress. The echocardiogram under basal conditions revealed a pseudoaneurysm in the anterior wall of the aortic root (Figure 2A). Immediate TEE with the use of a 3-dimensional TEE probe (Philips, Andover, Ma) allowed us to better delineate the pseudoaneurysm ( Figure 2B). The pseudoaneurysm caused compression of the main left coronary artery and was therefore responsible for the angina (Figure 3 and...

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“…Furthermore, transapical approach is known to associated with the mortality from LV apical tear or rupture at the site of puncture, 3 and has also complications including LV apical false aneurysm, arrhythmias, and echocardiographic hypokinesia or akinesia of the LV apex. [4][5][6] With recent experiences, there were no significant differences in 30 day mortality or procedural complications between transapical approach and transaortic approach.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Aortic Valve Implantation Using CoreValve by Transaortic Approach

Park

Shim

et al. 2013

J Lipid Atheroscler

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This is an Open Access article distributed under the terms of the creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction: Transcatheter aortic valve implantation (TAVI) is now considered as an alternative treatment option for severe aortic stenosis (AS) patients who cannot undergo surgical aortic valve replacement (AVR). Case report: We describe the first Korean case of transaortic TAVI with mini-sternotomy using CoreValve. A 83-year-old woman with severe AS and recent history of non-ST elevation myocardial infarction was referred to our institution for TAVI intervention. There was no amenable peripheral vascular access for transfemoral or trans-subclavian approach. Considering the relatively high procedural risk of transapical approach in this patient, we performed transaortic TAVI with mini-sternotomy. Conclusion:The present case suggests transaortic approach may be an effective and safe strategy for TAVI in high risk severe AS patients without eligible femoral or subclavian access routes.

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Unexpected Complications of Transapical Aortic Valve Implantation

Cited by 111 publications

References 16 publications

Transaortic transcatheter aortic valve implantation: Results of the Polish arm of the ROUTE registry

Transaortic transcatheter aortic valve implantation: Results of the Polish arm of the ROUTE registry

Aortic Root Pseudoaneurysm 1 Year After Transapical Aortic Valve Implantation

Transcatheter Aortic Valve Implantation Using CoreValve by Transaortic Approach

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