Non-contrast trans-catheter aortic valve implantation using Evolut self-expanding platform: A wire backup technique case report

Background Concomitant aortic stenosis and chronic kidney disease (CKD) represent management challenge. Transcatheter aortic valve implantation (TAVI) is an established treatment for patients with symptomatic severe aortic stenosis but requires the use of contrast media, particularly, in patients undergoing self-expanding platform implantation. Therefore, patients with CKD remain at increased risk of developing worsening renal impairment post TAVI. Case summary Herein, we present 62-year-old male patient who was admitted with progressive dyspnoea. His transthoracic echocardiogram revealed severe aortic stenosis and impaired left ventricular systolic function (estimated ejection fraction of 35%). He has background of porcelain aorta and CKD. Despite low-dose contrast CT, the patient’s renal function significantly deteriorated. He was successfully treated with trans-catheter aortic valve implantation using self-expanding valve (Evolut) without the need for contrast media. The procedure was guided by catheter positioning in the non-coronary cusp and wire back-up technique in the left coronary cusp. Conclusion This case demonstrated the feasibility of implanting self-expanding trans-catheter heart valve using Evolut platform without the need for the use of contrast media in a patient at high-risk of worsening renal impairment. The current approach requires good procedural planning and additional vascular access and should be only used in highly selected cases.