“Ring Pledget” a New Concept for Secure Apex Closure during Transapical Aortic Valve Implantation

2010 ◽  
Vol 5 (2) ◽  
pp. 136-137 ◽  
Author(s):  
Parla Astarci ◽  
David Glineur ◽  
Joelle Kefer ◽  
Jean Renkin ◽  
Jean-Louis Vanoverschelde ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Critical Step ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Delivery Sheath

Transapical aortic valve implantation requires puncture of the left ventricle apex and insertion of a 32-French delivery sheath. A critical step in the procedure consists of secure closure of the ventricular apex. We describe 2 cases of apical rupture of 42 transapical aortic valve implantations. Furthermore, we describe the use of a newly designed single circular Teflon pledget that can help to avoid this complication. This pledget provides a more secure and uniform shrinkage of the entire apex to close the defect left by the delivery sheath.

scholarly journals Transcatheter Aortic Valve Implantation: All Transfemoral? Update on Peripheral Vascular Access and Closure

2021 ◽  
Vol 8 ◽  
Author(s):  
Nils Perrin ◽  
Guillaume Bonnet ◽  
Lionel Leroux ◽  
Réda Ibrahim ◽  
Thomas Modine ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Peripheral Vascular ◽  
Technical Improvement ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Artery Disease ◽  
Valve Implantation ◽  
Transfemoral Tavi ◽  
Delivery Sheath

Transfemoral access remains the most widely used peripheral vascular approach for transcatheter aortic valve implantation (TAVI). Despite technical improvement and reduction in delivery sheath diameters of all TAVI platforms, 10–20% of patients remain not eligible to transfemoral TAVI due to peripheral artery disease. In this review, we aim at presenting an update of recent data concerning transfemoral access and percutaneous closure devices. Moreover, we will review peripheral non-transfemoral alternative as well as caval-aortic accesses and discuss the important features to assess with pre-procedural imaging modalities before TAVI.

scholarly journals Successful transcatheter aortic valve implantation in a patient after an apico-aortic conduit for severe aortic stenosis complicated by haemolytic anaemia: a case report

2020 ◽  
Author(s):  
Kitae Kim ◽  
Natsuhiko Ehara ◽  
Tadaaki Koyama ◽  
Yutaka Furukawa
Keyword(s):  
Shear Stress ◽  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Haemolytic Anaemia ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Apico-aortic conduit (AAC) which connects the left ventricular (LV) apex directly to the descending aorta through a valved conduit, is an alternative to surgical aortic valve replacement (AVR) for patients with aortic stenosis (AS) who are inoperable or high risk for surgical AVR and are not suitable candidates for transcatheter aortic valve implantation (TAVI). Case summary An 84-year-old man with severe AS underwent an AAC combined with coronary artery bypass grafting 8 years earlier. A saphenous vein graft was anastomosed from the conduit to the left anterior descending artery. He had developed haemolytic anaemia requiring frequent blood transfusions. The stenosis at the anastomosis of the left ventricle and the conduit might be the cause of a turbulent flow and a shear stress which led to mechanical haemolysis. We expected that dilatation of native aortic valve would reduce the blood flow at the anastomosis site and thereby improve haemolytic anaemia. Since balloon aortic valvuloplasty improved haemolytic anaemia without exacerbation of myocardial ischaemia, transsubclavian TAVI was performed. After the TAVI, significant reductions in the pressure gradient between the left ventricle and the ascending aorta and that between the left ventricle and the conduit were achieved, and the patient remained clinically stable without the recurrence of haemolytic anaemia. Discussion This is the first report regarding mechanical haemolytic anaemia after AAC which might result from a turbulence and a shear stress by the stenosis of the anastomosis of the LV apex and the conduit. A careful monitoring for conduit dysfunction should be made after AAC.

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