Percutaneous Treatment of Concomitant Severe Aortic Stenosis and Thoracoabdominal Aortic Aneurysm

2021 ◽  
pp. 152660282110385
Author(s):  
Ariane-Sophie Painchaud-Bouchard ◽  
Jeannot Potvin ◽  
Jessica Forcillo ◽  
Ricardo Ruz ◽  
Stephane Elkouri
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Combined Treatment ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Percutaneous Treatment ◽  
Surgical Approaches ◽  
Transcatheter Aortic Valve ◽  
Clinical Scenarios ◽  
Successful Resolution

Purpose: Although rare in occurrence, symptomatic severe aortic stenosis and large thoracoabdominal aortic aneurysm (TAAA) found in combination pose a real therapeutic challenge, especially in elderly frail patients. Surgical approaches for combined treatment are complex and at high risk of complications while staged procedures carry the risk of an unfavorable evolution of the condition temporarily left untreated. Minimally invasive approaches may therefore prove a more suitable strategy for these patients. Case Report: We present the case of a 78-year-old woman with symptomatic severe aortic stenosis (AS) and a TAAA of 7.8 cm in diameter. Transcatheter treatment of both conditions was successfully performed in a staged manner. The first intervention consisted of combined transfemoral transcatheter aortic valve implantation (TAVI) immediately followed by a zone 3 thoracic endovascular aortic endoprosthesis deployment. In order to reduce the extent of intercostal arteries coverage and mitigate the risk of medullar ischemia, a second-stage percutaneous endovascular treatment of the TAAA was performed with a customized 4-fenestration prosthesis. Early and 12-month clinical and radiologic follow-up were favorable. Conclusion: This case demonstrates how a strong multidisciplinary collaboration allows for successful resolution of complex clinical scenarios.

Simultaneous Transcatheter Aortic Valve Implantation and Infrarenal Aortic Aneurysm Repair for Severe Aortic Stenosis and Abdominal Aortic Aneurysm: Report of 2 Cases and Literature Review

2020 ◽  
Vol 54 (6) ◽  
pp. 544-548
Author(s):  
Stylianos Koutsias ◽  
Georgios I. Karaolanis ◽  
Michail I. Papafaklis ◽  
Michail Peroulis ◽  
Petros Tzimas ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Valve ◽  
Aortic Aneurysm ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Transcatheter Aortic Valve ◽  
Abdominal Aortic ◽  
Aortic Valve Implantation ◽  
Valve Implantation

The prevalence of concomitant abdominal aortic aneurysm (AAA) and severe aortic stenosis (AS) has been increasing in the elderly population. Both conditions have adverse outcomes, if not adequately managed. No clear recommendations are available in the literature until today, in regards of the management sequence making thus the decision-making challenging. We report 2 cases of AAA and significant AS treated with endovascular aortic repair (EVAR) and transcatheter aortic valve implantation (TAVI) during the same procedure and a review of the literature on this topic. Based on our experience, the combined procedure with TAVI followed by EVAR seems to be feasible, safe, and effective while detailed preoperative planning and a carefully tailored management strategy by a multidisciplinary team are essential.

scholarly journals Transcatheter Aortic Valve Implantation in a Patient with Unicuspid Aortic Valve

2017 ◽  
Vol 44 (2) ◽  
pp. 127-130 ◽  
Author(s):  
Angelo Nascimbene ◽  
Pranav Loyalka ◽  
Igor D. Gregoric ◽  
Ricardo Bellera ◽  
Maan Malahfji ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Percutaneous Treatment ◽  
Aortic Insufficiency ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve

Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valves has been successfully performed, but there is a lack of published experience in percutaneous treatment of patients with unicuspid valves and severe aortic stenosis. We describe a case of TAVR in such a patient. A 31-year-old woman with Turner syndrome—who had undergone coarctation repair via subclavian flap at age 7 days and an aortic valvotomy at age 6 weeks—presented with severe symptomatic aortic stenosis. She was deemed inoperable because of her severe pulmonary hypertension and numerous comorbidities; consequently, a 20-mm Edwards Sapien 3 Transcatheter Heart Valve was offered for compassionate use. Postdeployment angiography and transesophageal echocardiography and aortography revealed no aortic insufficiency. Transcatheter aortic valve replacement for unicuspid aortic valve stenosis is technically feasible. Before implantation, particular attention should be paid to the interplay between the large single leaflet, coronary ostia, and stented valve, to select the correct size and position of the device. Some degree of intraoperative aortic migration should be anticipated.

scholarly journals Mixed-Valve Disease: Management of Patients with Aortic Stenosis and Mitral Regurgitation: Thresholds for Surgery Versus Percutaneous Therapies

2021 ◽  
Vol 15 ◽  
Author(s):  
Jean-Bernard Masson ◽  
Jessica Forcillo
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Percutaneous Treatment ◽  
Transcatheter Aortic Valve ◽  
Valve Implantation

Significant mitral regurgitation (MR), frequently seen in the presence of severe aortic stenosis (AS), results in an association that negatively affects prognosis and imposes particular challenges for both the assessment of the severity of valvular lesions and decisions regarding treatment allocation. This article reviews the available literature with regards to the assessment of MR and AS in the presence of both; surgical management and results in patients with concomitant AS and MR; the effect of MR on outcomes in patients undergoing transcatheter aortic valve replacement; the effect of transcatheter aortic valve replacement on MR severity; and percutaneous treatment for MR after transcatheter aortic valve implantation. The authors aim to provide assistance in the decision-making process to treat patients with either a higher-risk double-valve procedure or a simpler, but perhaps incomplete, single-valve option.

Management and Prevention of Vascular Complications Related to Transcatheter Aortic Valve Implantation and Aortic Aneurysm Repair Procedures – A Technical Note

2010 ◽  
Vol 5 (1) ◽  
pp. 81
Author(s):  
Andrea Pacchioni ◽  
Dimitris Nikas ◽  
Carlo Penzo ◽  
Salvatore Saccà ◽  
Luca Favero ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Aneurysm ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Vascular Complications ◽  
Technical Note ◽  
Closure Device ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) and endovascular aortic repair (EVAR) are increasingly being used as therapeutic options for patients with severe aortic stenosis who are ineligible for surgery and who have aortic aneurysm with suitable anatomical features. These procedures can be associated with severe complications, especially related to vascular access and the use of a large introducer sheath (from 18 to 24 French [Fr]). In this article we describe possible vascular complications emerging during TAVI and EVAR and their appropriate management, beginning with patient selection, the correct way to perform vessel puncture and the use of a vascular closure device, up to the recently proposed cross-over technique, which is thought to minimise the risk of dangerous consequences of vascular damage.

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