Key result
TAVR with CPB and snare traction succeeds despite severe horizontal heart and acute aortic angulation.
Why the study?
Performing TAVR in patients with extreme horizontal heart orientation and acute aortic angulation is technically challenging and carries higher procedural risks.
Case Report (n=1)
CPB, femoral artery long sheaths, and snare traction can facilitate successful TAVR in patients with extreme horizontal cardiac orientation and acute aortic angulation.
May enable TAVR in extreme aortic angulation; hypothesis-generating and requires validation in larger series.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become a first-line treatment for elderly patients with severe aortic stenosis since its first successful implementation in 2002. However, performing TAVR in patients with extreme horizontal heart orientation and acute aortic angulation is technically challenging and carries higher procedural risks. CASE SUMMARY: This case report describes a patient with severe aortic stenosis complicated by an extreme horizontal heart position and acute aortic angulation. Under the support of cardiopulmonary bypass (CPB), femoral artery long sheaths, and snare traction, the TAVR procedure was successfully completed. DISCUSSION: The success of this case provides valuable insights for managing complex TAVR procedures. TAKE-HOME MESSAGES: CPB provides critical hemodynamic support during TAVR in patients with extreme horizontal cardiac orientation, effectively preventing intraoperative circulatory collapse. Advancing a femoral artery long sheath combined with snare traction overcomes challenges when TAVR in cases of severe horizontal heart orientation and acute aortic angulation.
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Feng et al. (2025) conducted a case report in Severe aortic stenosis with extreme horizontal heart position and acute aortic angulation (n=1). Transcatheter aortic valve replacement (TAVR) with cardiopulmonary bypass and snare traction was evaluated on Successful completion of TAVR procedure. Transcatheter aortic valve replacement was successfully completed in 1 patient with severe horizontal heart orientation and acute aortic angulation using cardiopulmonary bypass and snare traction.
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