Transcatheter Aortic Valve Implantation in morphologically complex Root-Aneurysms

Markus Mach, Bernhard Winkler, David Santer, Harald Pisarik, Martin Grabenwöger

Hospital Hietzing, Department of Cardiovascular Surgery, Vienna, Austria

Date, time and location: 2018.05.26 17:00, Exhibition area, 1st Floor. Zone – C

Abstract

Sinus valsalvae aneurysm is currently considered an exclusion criterion for transcatheter aortic valve implantation (TAVI). The risk of adverse events such as device malpositioning and migration due to large annular size are higher in TAVI than in conventional surgery. We hereby report the case of a very frail 87-year-old gentleman who had been treated successfully with TAVI in the setting of severe aortic stenosis accompanied with a sinus valsalvae aneurysm. Accurate preoperative planning and device selection were crucial and challenging in this case notably because retrograde access of any kind other than the right subclavian site was not achievable as the patient received surgery for aortic coarctation in the past and presented with severe kinking and narrowing of the proximal descending aorta. The applied strategy was to obtain retrograde access from the right subclavian artery for pressure measurement and pigtail insertion. Transapical TAVI was then performed uneventfully under fluoroscopic and transesophageal echocardiography (TEE) guidance. A multidetector computed tomography (MDCT) evaluation at 6 month did not show device dislodgement or any other complications. We conclude that TAVI in patients with a sinus valsalvae aneurysm is feasible in highly selected cases after comprehensive preoperative evaluation.This innovative and safe approach may widen the indications for TAVR in a field that has strictly been avoided in the past.