scholarly journals The Use of BASILICA Technique to Prevent Coronary Obstruction in a TAVI-TAVI Procedure

2021 ◽  
Vol 10 (23) ◽  
pp. 5534
Author(s):  
Ana Paula Tagliari ◽  
Rodrigo Petersen Saadi ◽  
Eduardo Ferreira Medronha ◽  
Eduardo Keller Saadi
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve ◽  
Valve In Valve ◽  
Aortic Valve Implantation ◽  
Coronary Ostia ◽  
Valve Implantation ◽  
Artery Obstruction ◽  
Coronary Obstruction

Transcatheter aortic valve implantation (TAVI) to manage structural bioprosthetic valve deterioration has been successful in mitigating the risk of a redo cardiac surgery. However, TAVI-in-TAVI is a complex intervention, potentially associated with feared complications such as coronary artery obstruction. Coronary obstruction risk is especially high when the previously implanted prosthesis had supra-annular leaflets and/or the distance between the prosthesis and the coronary ostia is short. The BASILICA technique (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction) was developed to prevent coronary obstruction during native or valve-in-valve interventions but has now also been considered for TAVI-in-TAVI interventions. Despite its utility, the technique requires a not so widely available toolbox. Herein, we discuss the TAVI-in-TAVI BASILICA technique and how to perform it using more widely available tools, which could spread its use.

scholarly journals P218 Accuracy and reproducibility of aortic root assessment by eSie Valves in patients candidate to transcatheter aortic valve implantation: a comparative study with computed tomography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Granata ◽  
A Veltri ◽  
S Iuliano ◽  
V Romano ◽  
S Stella ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Aortic Root ◽  
3D Model ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Coronary Ostia ◽  
Valve Implantation

Abstract Background Accurate imaging assessment of the aortic root (AR) is critical for prosthesis sizing in transcatheter aortic valve implantation. Multislice computed tomography (MSCT) is the gold standard for this purpose. 3D transesophageal (3D-TOE) reconstruction tools have recently been introduced, which automatically configures a geometric model of AR from 3D-TOE dataset and perform quantitative analyses of the AR. Purpose The aim of the study was to compare semi-automated measurements of AR obtained by eSie Valves (EV) (Siemens Medical Solution, California, USA) tool with MSCT. Methods We prospectively enrolled 26 consecutive patients (mean age 79.5 ± 7.5 years; 38% men) with severe symptomatic aortic stenosis (mean gradient 48.8± 13.6 mmHg) who underwent both 3D-TOE and MSCT as part of TAVI evaluation protocol. Volumetric datasets of the AR, acquired with 3D-TOE in mid-esophageal view, were analyzed with EV tool. EV tool automatically detected AR landmarks and, after user validation, created 3D model of AR providing values of area, perimeter, diameters of aortic annulus (AA) and coronary ostia heights (Fig 1). Results EV tool analysis on 3D-TOE volumetric data sets was feasible in all patients. Strong correlation between EV tool and MSCT assessment for AA major diameter (r = 0.79), AA minor diameter (r = 0.81), AA perimeter (r = 0.89) and AA area (r = 0.89) (all p< 0.0001) was found. On average EV tool underestimated MSCT measurements of AA major diameter (1.2 mm, 4.5%), AA minor diameter (2.6 mm, 11.3%), AA perimeter (4 mm, 5.2%) and AA area (65.3 mmq, 13.6%). Moderate correlation between the two methods, already in this initial sample, for right coronary artery ostium height (r = 0.53, p = 0.007) was discovered. Finally, weak correlation for left coronary artery ostium height (r = 0.33, p = 0.1) was revealed. EV tool measurements from two different volumetric datasets of the same patient showed an excellent reproducibility intraclass correlation coefficient (ICC) for AA area 0.94 and ICC for right coronary height 0.98. Conclusion With these initial results EV tool could be used in clinical practice for quick and reliable assessment of AA area, perimeter and diameters. A larger group of patients will be needed to assess the consistency of coronary ostia height evaluation by EV tool. Abstract P218 Figure. eSie Valve landmarks and 3D model of AR

scholarly journals The First Experience of Aortic Valve Repeated Replacement Using the “Valve in Valve” Technique in a Patient With Dysfunction of a Biological Prosthesis

2021 ◽  
Vol 10 (3) ◽  
pp. 582-588
Author(s):  
V. V. Vladimirov ◽  
L. S. Kokov ◽  
A. I. Kovalyov ◽  
S. S. Niyazov ◽  
M. V. Parkhomenko ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Practice ◽  
Aortic Valve ◽  
Older Patients ◽  
Surgical Risk ◽  
Transcatheter Aortic Valve ◽  
High Surgical Risk ◽  
Valve In Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Introduction. Aortic valve replacement in cardiopulmonary bypass with suture fixation of the prosthesis is the “gold standard” in cardiac surgery. Currently, the frequency of use of heart valve bioprostheses is increasing in older patients. Despite all the advantages of using heart valve bioprostheses, this type of prosthesis has a major drawback - it is not durable. In most cases, the reason for the dysfunction of prostheses in the late postoperative period is early calcification of the prosthesis valves or their rupture due to degeneration. With the development of new “gentle” techniques for replacing heart valves, transcatheter aortic valve implantation was introduced into clinical practice. The use of transcatheter aortic valve implantation (TAVI) “valve in valve” for reoperations in older patients is of great interest, since in recent years the procedure has been widely used in clinical practice and shows promising data in patients with high surgical risk.Aim of study. Show first experience of using a technique «valve in valve» at N.V. Sklifosovsky Research Institute for Emergency Medicine.Material and methods. The results of surgical treatment of a patient with aortic valve bioprosthesis dysfunction using the TAVI “valve in valve” technique are presented.Results. The use of the TAVI “valve in valve” method made it possible to perform reprosthetics of the aortic valve (AV) from a transfemoral approach, not to increase the volume of intervention during reoperation, to avoid trauma to the structures of the heart and nearby tissues when accessing the AV in a patient with a high surgical risk.Conclusion. The use of the TAVI “valve in valve” method in cardiac surgery makes it possible to achieve good immediate and long-term results when it is necessary to replace the AV in patients with a high surgical risk.

scholarly journals Balloon aortic valvuloplasty (BAV) as a bridge to aortic valve replacement in cancer patients who require urgent non-cardiac surgery

2014 ◽  
Vol 48 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Polonca Kogoj ◽  
Rok Devjak ◽  
Matjaz Bunc
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Balloon Aortic Valvuloplasty ◽  
Transcatheter Aortic Valve ◽  
Aortic Valvuloplasty ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background. Balloon aortic valvuloplasty (BAV) is a percutaneous treatment option for severe, symptomatic aortic stenosis. Due to early restenosis and failure to improve long term survival, BAV is considered a palliative measure in patients who are not suitable for open heart surgery due to increased perioperative risk. BAV can be used also as a bridge to surgical or transcatheter aortic valve implantation (TAVI) in haemodinamically unstable patients or in patients who require urgent major non-cardiac surgery. Patients and methods. We reported on 6 oncologic patients with severe aortic stenosis that required a major abdominal and gynaecological surgery. In 5 cases we performed BAV procedure alone; in one patient with concomitant coronary artery disease we combined BAV and percutaneous coronary intervention (PCI). Results. With angioplasty and BAV we achieved a good coronary artery flow and an increase in aortic valve area without any periprocedural complications. After the successful procedure, we observed a hemodynamic and symptomatic improvement. As a consequence the operative risk for non-cardiac surgery decreased and the surgical treatment of cancer was done without complications in all the 6 cases. Conclusions. BAV can be utilized as a part of a complex therapy in severe aortic stenosis aimed to improve the quality of life, decrease the surgical risk for major non-cardiac surgery or as a bridge to surgical or transcatheter aortic valve implantation.

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