TECHNIQUE
Ultrasound and fluoroscopic guidance were used to gain access to the
bilateral common femoral arteries using a micropuncture needle
technique. A 6 Fr long sheath was placed in the left femoral vein. In
the right common femoral artery, 2 Perclose ProGlide closure device was
deployed in a pre-close fashion. A 5 Fr balloon tipped temporary
transvenous pacemaker was placed in the right ventricular apex and a 6
Fr pigtail catheter was placed at the base of the aortic valve.
Aortography was performed to obtain an optimal angle for valve
deployment. The aortic valve was crossed via the right common femoral
arterial approach and a long Confida wire was placed in the left
ventricular apex.
In both cases, an initial Medtronic Evolut valve was advanced over a
Confida wire and utilized for the TAVR-procedure. The valve was deployed
with the assistance of small dye injections through the pigtail
catheter, so as to carefully choose the location for deployment. After
the valve was deployed, we noticed the valve had migrated into the Left
Ventricular Outflow Tract (LVOT), generating significant perivalvular
leakage. At that point, a Balloon-expandable Edwards SAPIEN valve was
chosen and placed within the initial Medtronic-Evolut valve, decreasing
the degree of aortic insufficiency to trace amounts.