Rapid Pacing Technique For Preventing Ventricular Tears during Transapical Aortic Valve Replacement

BACKGROUND: Transapical aortic valve replacement (TAVR) is emerging as an alternative to surgical aortic valve replacement in high-risk or non-operable patients with aortic stenosis. However, this approach might be associated with major bleeding complications during the removal of the introducer sheath from the left ventricular apex. We describe a simple technique to minimize this complication. METHODS: The technique consists of installing a temporary pacing Swan-Ganz catheter, using large-needle Ethibond 2-0 sutures with large pledgets for apical pursestrings, and removing the 26F sheath from the ventricular apex tension-free by rapid ventricular pacing (>150 bpm). RESULTS: We have completed 21 TAVR using rapid ventricular pacing. This technique considerably decreased the amount of apical tearing and sutures to be added at the apex. Six of 21 patients had partial ventricular tearing that was amenable to repair using rapid pacing, thereby avoiding urgent cardiopulmonary bypass. CONCLUSION: The present report describes a technique to reduce the occurrence of ventricular tears and major bleeding during TAVR.