“Use of Snare Catheter Technique in Transcatheter Aortic Valve Replacement With Self‐Expandable Valve: Expert Review”

Figures

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  Illustration 1. TAVR‐associated valve migration. [Color figure can be viewed at wileyonlinelibrary.com]

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  Illustration 2. Complex anatomies that make it difficult to ascend the delivery system. [Color figure can be viewed at wileyonlinelibrary.com]. [Correction added on 25 January 2025, after first online publication: In the image of Illustration 2, the word “morfology” has been changed to “morphology”.]

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  Figure 1. Regrade valve migration Evolut R #29. (A) Migration of the valve during deployment due to the asynchronous movements between the first and second implanters, the valve remained anchored in the aortic annulus through the upper crown (yellow line). (B) Snare catheter placement at the level of the upper post (blue arrow). (C) Careful retraction, supported by the injection of contrast medium through the pigtail (yellow arrow) to locate the anatomical references. (D) Valve in the proper position, without evidence of paravalvular leakage, without damage to the valve structure. [Color figure can be viewed at wileyonlinelibrary.com]

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  Figure 2. Regrade valve migration Allegra # 27. (A) Valve migration immediately upon deployment. (B−D) Antegrade traction with two snare catheters (yellow arrows) through a femoral approach through the sheath of the delivery system. [Color figure can be viewed at wileyonlinelibrary.com]

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  Figure 3. Anterograde valve migration portico # 27. (A) Valve placed in annular position. (B) At the time of removing the delivery system, the nose cone got stuck with the base of the valve and was pulled toward the aortic root in the aortographic control, where a decrease in left system flow was observed (yellow arrow). (C) A snare catheter was looped at the level of the upper crown near the lesser curvature. (D and E) Retraction of the valve toward the ascending aorta was performed. [Color figure can be viewed at wileyonlinelibrary.com]

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  Figure 4. Anterograde valve migration accurate neo 2 # 27. (A) Anterograde migration during postdilation, due to premature removal of pacing during postdilation. (B and C) A snare catheter was advanced through the femoral approach and a 0.035‐inch guidewire was advanced through the pigtail catheter via the radial route. The 0.035‐inch guidewire was looped and pulled toward the descending aorta with the snare catheter. (D) A second valve was placed in the annular plane and its functionality was confirmed. (E) The permeability of the emerging vessels was confirmed (blue arrows). [Color figure can be viewed at wileyonlinelibrary.com]

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  Figure 5. Retrograde retraction. (A) Excessive traction was performed on the portico #27 valve, taking it very close to the emergence of the supra‐aortic trunks (blue arrow). (B) It was looped from the base (red arrow) and retrograde retraction was performed to free the supra‐aortic trunks. (C) After retrograde retraction, the tension of the snare catheter was maintained to provide stability and avoid displacement of the migrated valve while the second valve was raised to the annular plane (D) aortography to visualize the patency of the coronary arteries. [Color figure can be viewed at wileyonlinelibrary.com]

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  Figure 6. Porcelain aorta. (A) Patient with a porcelain aorta with abundant calcification at the level of the aortic arch (B) at the moment the release system is raised, it is observed how the release system collides with the greater curvature at the level of the aortic arch due to extensive calcification (blue arrow). (C and D) A snare catheter was placed ipsilaterally, and with this, traction was performed toward the lesser curvature, which successfully advanced to the annular plane (yellow arrow). [Color figure can be viewed at wileyonlinelibrary.com]

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  Figure 7. Horizontal aorta. (A) Significant aortic angulation. (B) Difficulty in advancing the delivery system at the level of the valve plane (blue arrow). (C and D) Use of a snare catheter for coaxalization of the release system and advancement to the annular plane. (D) Successful valve placement. [Color figure can be viewed at wileyonlinelibrary.com]

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  Figure 8. Horizontal aorta behavior. (A) Severe aortic stenosis, with an angulation of 42°. (B) Bicuspid morphology and eccentricity of the aortic orifice. (C) Angulation of the guide that simulated a horizontal aorta despite a normal angulation of the aortic root (red arrow), which generated difficulty for the advancement of the delivery system to the annular plane, even using a guide with greater support. (D) So, the use of a snare catheter was chosen for coaxalization of the delivery system. (E) When the delivery system crossed the valve plane, the verticalization of the system was observed, indicating the absence of a horizontal aorta (yellow arrow). [Color figure can be viewed at wileyonlinelibrary.com]