Preoperative Risk Levels and Vascular Access in Transcatheter Aortic Valve Implantation-A Single-Institute Analysis-

2016 ◽  
Vol 41 (2) ◽  
pp. 130-138 ◽  
Author(s):  
Akira T. Kawaguchi ◽  
Jean Philippe Collet ◽  
Philippe Cluzel ◽  
Ralouka Makri ◽  
Mojgan Laali ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Vascular Access ◽  
Preoperative Risk ◽  
Risk Levels ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

scholarly journals Transcatheter Aortic Valve Implantation Despite Challenging Vascular Access

2015 ◽  
Vol 42 (2) ◽  
pp. 144-147
Author(s):  
Angelo Nascimbene ◽  
Federico Azpurua ◽  
James J. Livesay ◽  
R. David Fish ◽  
Zvonimir Krajcer
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Vascular Access ◽  
Severe Aortic Stenosis ◽  
Severe Heart Failure ◽  
Common Femoral Artery ◽  
Infrarenal Aorta ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

We describe transcatheter aortic valve implantation in a patient who had severe peripheral artery disease. The patient's vascular condition required additional preliminary peripheral intervention to enable adequate vascular access. A 78-year-old man with severe aortic stenosis, substantial comorbidities, and severe heart failure symptoms was referred for aortic valve replacement. The patient's 20-mm aortic annulus necessitated the use of a 23-mm Edwards Sapien valve inserted through a 22F sheath, which itself needed a vessel diameter of at least 7 mm for percutaneous delivery. The left common femoral artery was selected for valve delivery. The left iliac artery and infrarenal aorta underwent extensive intervention to achieve an intraluminal diameter larger than 7 mm. After aortic valvuloplasty, valve deployment was successful, and the transaortic gradient decreased from 40 mmHg to less than 5 mmHg. The patient was discharged from the hospital 4 days postoperatively. We conclude that transcatheter aortic valve implantation can be successfully performed in patients with obstructed vascular access, including stenosis of the infrarenal aorta and the subclavian and coronary arteries.

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