Transfemoral TAVR was successfully performed in a patient with a super-stiff aortic arch using balloon-assisted tracking combined with a long sheath.
Case Report (n=1)
Balloon-assisted tracking combined with a long sheath can facilitate successful transfemoral TAVR in patients with extremely stiff anatomy, such as those with prior aortic arch replacement.
Abstract Background Transfemoral transcatheter aortic valve replacement (TAVR) is challenging in patients with stiff and tortuous anatomy. In the present case, we presented a patient with super stiff aortic arch (prior history of aortic arch replacement, stent implantation and anastomotic fistula plugging) and a summary of strategies for managing such stiff approach. Case summary A 59-year-old man with symptomatic severe aortic stenosis and a super-stiff aortic arch underwent transfemoral TAVR. Techniques including buddy wire, balloon deflection, balloon-assisted tracking, snare assistance, and long sheath use were considered. Balloon-assisted tracking combined with a long sheath ultimately enabled successful TAVR. Supra-annular anchoring was also confirmed in this case. Discussion For patients with extremely stiff anatomy, multiple techniques may facilitate successful transfemoral TAVR. Furthermore, in bicuspid aortic valve cases, the narrowed supra-annular region can serve as an effective anchoring zone.
Yang et al. (Sun,) conducted a case report in Symptomatic severe aortic stenosis and a super-stiff aortic arch (n=1). Transfemoral transcatheter aortic valve replacement (TAVR) using balloon-assisted tracking and a long sheath was evaluated on Successful TAVR. Transfemoral TAVR was successfully performed in a patient with a super-stiff aortic arch using balloon-assisted tracking combined with a long sheath.