Key result
Intentional stiff wire pre-shaping facilitates successful transfemoral TAVR deployment across a severely tortuous aorto-subclavian graft.
Why the study?
TF TAVR can be challenging in patients with prior aortic coarctation repair and bypass grafts due to extreme tortuosity.
Does intentional pre-shaping of a stiff wire facilitate transfemoral TAVR device traversal in a patient with severe tortuosity from a prior aorto-subclavian bypass graft?
Case Report (n=1)
Does intentional pre-shaping of a stiff wire facilitate transfemoral TAVR device traversal in a patient with severe tortuosity from a prior aorto-subclavian bypass graft?
Intentional pre-shaping of a stiff wire can facilitate transfemoral TAVR delivery in patients with extreme tortuosity due to prior aortic coarctation bypass grafts.
Supports TAVR feasibility in coarctation with bypass grafts; leaves open need for prospective validation before broader adoption.
BACKGROUND: Transfemoral (TF) TAVR can be challenging in patients with prior aortic coarctation repair and bypass grafts due to extreme tortuosity. CASE: A 74-year-old man with severe symptomatic aortic stenosis and a prior left-subclavian-to-descending aortic bypass presented for TAVR. CT showed a large, calcified annulus (perimeter-derived diameter 27.6 mm; area 573.7 mm²) and a serpiginous, calcified bypass graft. After initial failure to advance the system through the graft, we pre-shaped a Lunderquist wire with an acute bend ~40 cm from the tip to redirect the delivery vector. A 27.5-mm balloon-expandable MyVal was then advanced and deployed uneventfully, with no paravalvular leak. CONCLUSION: Intentional pre-shaping of a stiff wire can facilitate TF device traversal across aorto-subclavian bypass grafts with severe tortuosity, enabling safe, precise deployment when TF remains the preferred route.
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Papadopoulos et al. (2025) conducted a case report in Severe symptomatic aortic stenosis and prior aortic coarctation bypass graft (n=1). Transfemoral TAVR with pre-shaped Lunderquist wire was evaluated on Successful valve deployment. Intentional pre-shaping of a stiff wire facilitated successful transfemoral TAVR deployment across a severely tortuous aorto-subclavian bypass graft.
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