Vittorio Romano

Transfemoral transcatheter aortic valve implantation in patients with small diseased peripheral vessels

OBJECTIVES The aim of this study was to assess the feasibility, safety and short-term outcomes of transfemoral transcatheter aortic valve implantation (TF-TAVI) in patients with small diseased peripheral vessels. BACKGROUND The transfemoral (TF) route for transcatheter aortic valve (TAVI) is the default option due to associated advantages. However, this is limited due to the high prevalence of significant peripheral arterial disease and increased risk of vascular complications. METHODS Of 539 consecutive patients undergoing TAVI in a single Italian center, 23 patients underwent TF-TAVI in the presence of small peripheral vessels as defined by a minimal luminal diameter (MLD) of ≤5.5mm [by computed tomography (CT)] and/or the inability to advance a large-bore sheath. Calcification was defined as being concentric if calcium extended more than 270° around the circumference of the artery. All patients underwent 30-day clinical follow-up. RESULTS 17 (73.9%) patients underwent peripheral vessel pre-dilatation with a semi-compliant balloon and 6 (26.1%) patients with a Solopath sheath. 6 (26.1%) patients suffered a peri-procedural complication, with 1 patient requiring surgical embolectomy for thrombotic occlusion and the remaining patients successfully managed percutaneously in the catheter laboratory. No patient suffered a vessel perforation or required implantation of a covered stent. At 30-day follow-up, all patients were free of symptoms and signs or symptoms of peripheral vascular disease, with well-functioning TAVI prostheses as evaluated by echocardiography. CONCLUSIONS Performing TF-TAVI is feasible in patients with no other viable vascular access option in the presence of small MLD and calcification of the peripheral vasculature, with any anticipated acute vascular complication managed in the catheter laboratory with established percutaneous techniques.

TCT-698 Comparison of the fully repositionable and retrievable Lotus Valve and Direct Flow Medical Valve for the treatment of severe aortic stenosis: a high-volume single center experience

A limitation of first generation transcatheter aortic valve replacement (TAVR) devices was the occurrence of paravalvular leak (PVL) that when greater than mild has been demonstrated to a predictor of mortality. Second generation devices have been designed to reduce this. One technological advance

A comparison of the fully repositionable and retrievable Boston Lotus and direct flow medical valves for the treatment of severe aortic stenosis: A single center experience

Second generation transcatheter aortic valve implantation (TAVI) devices have been designed to reduce the rate of paravalvular leak (PVL) and other complications. An important technological advancement has been the ability to fully reposition devices to facilitate optimal implantation depth and position to reduce the likelihood of PVL.

Use of a parallel stiff wire to facilitate percutaneous Impella RP ventricular assist device positioning

Despite optimal medical management, some patients with severe right ventricular failure fail to respond and may benefit from additional support with the implantation of a RV assist device. Experience to date with Impella RP is limited. We report a case of percutaneous Impella RP implantation, using a parallel stiff wire to reduce anatomical tortuosity by acting as a buddy-wire to facilitate device implantation and reduce the risk of tricuspid ring damage in a patient recently treated with tricuspid ring annuloplasty.

Use of Double Stiff Wire Allows Successful Transfemoral Transcatheter Aortic Valve Implantation Through Extreme Thoracic Aorta Tortuosity

An 80-year-old man affected by symptomatic (New York Heart Association III) aortic stenosis was referred to our center. Transthoracic echocardiogram showed low-flow low-gradient aortic stenosis (mean gradient 30 mm Hg, valve area 0.6 cm2, ejection fraction 35%). His past medical history included liver cirrhosis in chronic hepatitis C infection (Child-Pugh A6) and severe osteoporosis with chest deformation and restrictive pulmonary disease. His EuroSCORE was 15.4% and Society of Thoracic Surgeons score was 4.8%. Preoperative computed tomography revealed significant tortuosity of the descending thoracic aorta, with a double curve (Figure 1A–1C; Movie I in the Data Supplement) and a narrowest lumen diameter of 18 mm. Significant kinking was also present at the level of the right femoro-iliac axis (Figure 1B) with a minimum diameter was 9.1 mm at both sides. His aortic annulus size was calculated at 25×27 mm (area 540 mm2). After Heart Team discussion, in view of his multiple comorbidites, he was submitted to transcathter aortic valve implantation. Transfemoral route was deemed the most suitable access route because of the presence of restrictive pulmonary disease and increased associated risk with …

Anatomic and procedural associations of transcatheter heart valve displacement following Evolut R implantation: Anatomic and procedural associations of transcatheter heart valve displacement following Evolut R implantation

This study aimed to predict the displacement of self‐expanding transcatheter heart valves (THV) during final deployment.

A Novel Technique for Prosthetic Valve Retrieval After Transcatheter Aortic Valve Embolization

Although the rate of procedural complications during transcatheter aortic valve implantation has decreased because of technological advancement and increased operator experience, device embolization remains a rare but potentially fatal complication, even with new generation devices. We report, to our knowledge, the first case of Portico valve (St Jude Medical, Minneapolis, MN) migration despite apparent optimal initial implantation depth, which was retrieved using a novel strategy after failure of a traditional retrieval technique. We also describe a mechanism of left coronary artery systolic perfusion with diastolic backflow, which led to myocardial ischemia.