An Unusual Femoral Sheath Severing with Successful Recapture: A Case Report

Reports ◽  
2021 ◽  
Vol 4 (4) ◽  
pp. 34
Author(s):  
Frane Runjić ◽  
Andrija Matetic ◽  
Matjaž Bunc ◽  
Nikola Crnčević ◽  
Ivica Kristić
Keyword(s):  
Case Report ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Balloon Catheter ◽  
Proximal Part ◽  
Ascending Aorta ◽  
Introducer Sheath ◽  
Transcatheter Aortic Valve ◽  
Coronary Cusp

This study presents a case of a successful severed femoral sheath recapture during transfemoral transcatheter aortic valve replacement (TAVR). During skin tunneling with a scalpel, the discontinuity of the femoral sheath occurred. Grasping of the distal sheath with the surgical hemostat was attempted unsuccessfully. A proximal part of the severed sheath was removed and Medtronic Sentrant introducer sheath (14 French) was then placed over the existing Confida wire which permanently remained in position, followed by the introduction of the Amplatz Left 2 (AL2) catheter which pushed the severed sheath in the ascending aorta over the Confida wire. The crucial maneuver was the entanglement of the severed sheath in the aortic non-coronary cusp which allowed for its entrapment by the AL2 catheter. This allowed for the coronary guidewire BMW Universal (0.014”) placement and a slow balloon retrieval (SeQuent NEO 2.5 x 25 mm) of the severed sheath into the introducer sheath. The guidewire/balloon catheter was then exchanged for the support wire (0.035”) followed by the removal of the introducer sheath, AL2 catheter and the severed sheath. In conclusion, sheath severing is a complex accidental event during TAVR, which can be solved by intra-aortic recapture and retraction.

scholarly journals One-stage off pump combined transapical aortic valve replacement and ascending aorta endografting

2020 ◽  
Author(s):  
Gino Gerosa ◽  
Giorgia Cibin ◽  
Michele Antonello ◽  
Augusto D’Onofrio
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Ascending Aorta ◽  
Off Pump ◽  
Stent Grafting ◽  
Transcatheter Aortic Valve ◽  
Custom Made ◽  
Risk Patients

Abstract An 84-year-old patient was referred for severe symptomatic aortic valve stenosis and focal chronic dissection of the ascending aorta. After multidisciplinary discussion, the patient was scheduled for combined transapical transcatheter aortic valve replacement and ascending aorta stent-grafting. The procedure was performed with a balloon aortic valvuloplasty followed by a custom-made stent graft implantation into the ascending aorta and then by balloon-expandable transapical transcatheter aortic valve replacement. The patient had an uneventful hospital stay. In conclusion, in selected high-risk patients, transapical combined ascending aorta stent-grafting and transcatheter aortic valve replacement are feasible and safe.

scholarly journals Case Report: Post transcatheter aortic valve replacement shock: Value of multimodal imaging

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2032 ◽  
Author(s):  
Sujatha P. Bhandary ◽  
Andrew J. Otey ◽  
Thomas J. Papadimos ◽  
Juan A. Crestanello ◽  
Barry S. George ◽  
...  
Keyword(s):  
Case Report ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Multimodal Imaging ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
Transcatheter Aortic Valve

Complications resulting from the delayed clinical presentation of a left main coronary artery obstruction can be catastrophic. This case report presents a 73-year-old woman with severe aortic stenosis who underwent transcatheter aortic valve replacement with a core valve who, approximately 20 minutes after heparin reversal with protamine, became hypotensive and was unresponsive to vasopressor and inotropic therapy. Transesophageal echocardiography demonstrated global hypokinesis, which was highly consistent with the occlusion of the left main coronary artery. Angiography confirmed this diagnosis and demonstrated that valve positioning had not changed compared to post-placement examination. Here we report the partial covering of the ostium of the left main coronary artery by a core valve skirt that converted into a total occlusion following the initiation of heparin reversal with protamine and the value of multimodal imaging in the management of this case.

scholarly journals Prosthetic valve endocarditis after transcatheter aortic valve replacement: A case report and current review

2017 ◽  
Vol 4 (2) ◽  
pp. 10
Author(s):  
Tarek Chami ◽  
Guilherme Attizzani
Keyword(s):  
Case Report ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
Transcatheter Aortic Valve ◽  
Current Review

Prosthetic valve endocarditis (PVE) after transcatheter aortic valve replacement (TAVR) is a rare but very serious and often deadly complication. Despite that, data are scarce and limited. Here, we report a case of a patient who developed PVE three months following TAVR and review the literature.

Suprasternal Transcatheter Aortic Valve Replacement in Patients with Marginal Femoral Access

2018 ◽  
Vol 13 (1) ◽  
pp. 1-4 ◽  
Author(s):  
Andy C. Kiser ◽  
Thomas G. Caranasos ◽  
Mark D. Peterson ◽  
David M. Holzhey ◽  
Philipp Kiefer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Innominate Artery ◽  
Ascending Aorta ◽  
Intermediate Risk ◽  
Surgical Aortic Valve Replacement ◽  
Femoral Access ◽  
Transcatheter Aortic Valve

Objective Recently, the PARTNER 2A trial reported results of transcatheter aortic valve replacement versus surgical aortic valve replacement in 2032 intermediate-risk patients at 2 years. Two hundred thirty-six patients (24%) required an access route other than transfemoral. Compared with transfemoral and surgical aortic valve replacement, nontransfemoral transcatheter aortic valve replacement was associated with a numerically higher rate of death and disabling stroke at 30 days. This underscores the need for a better alternative surgical approach for patients with marginal femoral access. We reviewed our multicenter experience with minimally invasive suprasternal transcatheter aortic valve replacement. Methods Consecutive patients with symptomatic severe aortic stenosis at high or intermediate risk for surgical aortic valve replacement underwent suprasternal transcatheter aortic valve replacement. A commercially available transcatheter heart valve was deployed under fluoroscopic guidance through the innominate artery or ascending aorta. Using a 3-cm skin incision just above the sternal notch, the Aegis Transit System (Aegis Surgical Ltd, Galway, Ireland) provided illuminated access to the mediastinum without bone disruption. Through a purse-string suture placed in the innominate artery or ascending aorta, transcatheter aortic valve replacement proceeded similarly to the direct aortic approach. Results Thirty patients at six medical centers successfully underwent suprasternal transcatheter aortic valve replacement. Implanted valves included 2 CoreValve and 12 Evolut-R (Medtronic, Inc, Minneapolis, MN USA), as well as 10 SAPIEN 3 and 6 SAPIEN XT (Edwards Lifesciences, Corp, Irvine, CA USA) with sizes ranging from 23 to 31 mm. Median procedure time was 90 minutes and median hospital stay was 4 days. Postoperatively, new permanent pacemaker (n = 3) was the most common Vascular Academic Research Consortium 2 complication. Conclusions These data demonstrate the early clinical feasibility of suprasternal transcatheter aortic valve replacement. Key advantages of this approach include direct access to the innominate artery and ascending aorta, precise sheath control, and confident arterial closure. Additional experience is warranted to confirm these favorable results.

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